128层螺旋CT在冠心病诊断中的应用研究

Application of 128-slice spiral CT in diagnosis of coronary heart disease

目的研究128层螺旋CT冠脉成像对冠心病的冠状动脉狭窄,特别是细小分支狭窄的临床诊断价值和准确度。方法以传统X线冠状动脉造影(CAG)为金标准,与同期2～7d内行64排128层螺旋CT的图像进行对比研究。结果本研究中CT图像能够满足冠状动脉管腔评价的节段占96.50%,CT图像满足诊断要求的节段中,常规冠状动脉造影共发现中度和中度以上狭窄120节段,其中重度狭窄34节段。本组病例中以CAG作为金指标,显示重度狭窄的敏感度和特异度分别为99.8%和96.6%,阳性预测值和阴性预测值分别为99.8%和96.5%。结论对于达到扫描评价条件的冠脉图像,128层螺旋CT可作为冠心病临床诊断及介入治疗的一种无创筛选方法;能较可靠地排除临床表现不明确的冠心病患者,尤其是评价左主干、左前降支和回旋支的近端准确度非常高。

Objective To determine the value of 128-slice coronary CT angiogram （CTA） in detecting coronary artery stenosis. Methods 128-slice coronary CTA was compared with catheter coronary angiogram （CAG） performed within 2-7 days. Results 96.50% of coronary artery segments were evaluable on CTA. Compared to the moderate and severe stenosis in 120 segments including 34 segments with high-grade stenosis on CAG, the sensitivity, specificity, positive predictive value and negative predictive value of CTA were 99.8, 96.6, 99.80 and 96.5% respectively. Conclusion CTA has high sensitivity, specificity and negative predictive value in diagnosing coronary artery stenosis, especially in the left main, left anterior descending and proximal circumflex coronary arteries.