320排CT冠状动脉成像与冠状动脉造影的影像对比研究

The diagnostic value of 320-slice dynamic volume CT to coronary hear disease

目的以选择性冠状动脉造影(SCA)为"金标准"评价320排CT冠状动脉成像技术对诊断冠状动脉狭窄的准确性。方法选择冠心病诊断明确或可疑冠心病患者共86例(男49例,女37例)。所有患者的心律均为窦性心律,心率≥75次/min的患者口服倍他乐克控制心率;均同期行320排器官动态容积CT(DVCT)与SCA,将320排DVCT与SCA的结果进行对照研究,直径≥1.5mm的冠状动脉节段纳入结果分析,冠状动脉狭窄定义为≥50%的狭窄,分析320排DVCT对冠状动脉不同节段、不同分支狭窄判断的准确性;并根据有无伪影和是否符合进一步狭窄评价的要求将冠状动脉图像质量分为四个等级(Ⅰ～Ⅳ级)。结果 320排DVCT显示的1032个冠状动脉节段均符合影像学评价要求(Ⅰ～Ⅲ级);计算320排DVCT评价冠状动脉有无狭窄的总体敏感度、特异度、阳性预测值和阴性预测值分别为92.7%、96.1%、86.4%和98.0%,准确度为94.7%。结论 320排DVCT能清楚显示冠状动脉各分支节段,较为准确的诊断冠状动脉狭窄程度,亦可作为无创性诊断冠状动脉疾病的有力工具。

Objective To evaluate the accuracy in diagnosis of coronary artery stenosis by320-slice dynamic volume CT（ DVCT） in contrast to selective coronary angiography（ SCA）. Methods 320-slice dynamic volume CT angiography was performed in 86 patients （ 49 male,37 female） with known or suspected coronary artery disease（ CAD） and compared selective coronary artery angiography（ SCA）. The rhythm of all the Patients was stable sinus. Patients with initial heart rate≥75 bpm received β-blockers. All available coronary segments（ ≥1. 5 mm） were included in the evaluation. Lesions with≥50 luminal narrowing were considered significant stenosis. Evaluations had been done concerning the 320-slice dynamic volume CT for detecting the stenosis of the variant branches or segments of the coronary artery. According to the nature of motion artifacts and image evaluation for stenosis,image quality was ranked Ⅰ-Ⅳ. Results None of the coronary segments （ n =1032） needed to be excluded from analysis. SCA was used as the golden standard,Overall sensitivity for classifying stenosis was 92. 7% ,specificity was 96. 1% ,positive predictive value was 86. 4% ,and negative predictive value was 98. 0%. Aterial wall calcification was the main influence factor for accuracy of the assessment of coronary artery stenosis with 320-slice DVCT scanner. Conclusions 320-slice dynamic volume CT can display coronary artery images clearly,and can be a potential,noninvasive examination method for excluding coronary heart disease in patients with out typical precordial chest pain symptoms. 320-slice dynamic volume CT had high sensitivity and negative predictive value for detection of coronary significant stenosis,and will be a potential,noninvasive method for diagnosing coronary artery disease.