64排螺旋CT对冠状动脉粥样硬化斑块评价的临床研究

Evaluation of coronary atherosclerotic plaque with 64-multidetector row spiral computed tomography

目的以冠状动脉节段为基础,对照冠状动脉血管内超声(IVUS)结果,评价64排螺旋CT(64-MSCT)检查冠状动脉粥样斑块的能力及准确性。方法选择2009年11月至2010年1月50例怀疑或确诊的冠心病患者,其中男性38例,女性12例;年龄42～74岁,平均年龄55岁。行64-MSCT成像,2周内行冠状动脉IVUS,对186个冠状动脉斑块的64-MSCT及IVUS图像行对照研究。IVUS根据斑块回声特点将斑块分为钙化斑块、纤维斑块、软斑块(包括纤维脂质和坏死核心),64-MSCT则测量斑块密度,以CT值表示。结果对照IVUS结果,MSCT对出现任何粥样硬化斑块节段的诊断灵敏度为93.2%,特异度为91.6%。非钙化斑块组斑块含有较多的纤维和纤维脂质成分,与钙化斑块组相比差异具有统计学意义。与非钙化斑块组相比,混合斑块组和钙化斑块组含有较多的坏死核心成分。结论 64-MSCT具有良好的检查冠状动脉粥样斑块的能力,64-MSCT与IVUS结果具有相关性。

Objective To evaluate the ability and accuracy in detection of atherosclerotic plaque with 64-multidetector row spiral computed tomography（64-MSCT）,and compare the findings of intravascular ultrasound（IVUS） on the basis of coronary segments.Methods From November 2009 to January 2010,50 patients with suspected or confirmed coronary artery disease were enrolled,male 38,female 12,aged 42-74 years old,mean age 55 years old.The 64-MSCT images were performed,and the coronary IVUS performed within 2-week.The images of 186 coronary artery plaque with 64-MSCT and IVUS were control studied,plaques in IVUS were calcified plaque,fibrous plaque and soft plaque accorded to the echo characteristics.64-MSCT were measured the patch density,and indicated the CT value.Results A total of 186 coronary artery segments were imaged and analyzed,the sensitivity of 65-MSCT in atherosclerotic plaque segment was 93.2 % and specificity was 91.6 %,which compared with IVUS results.The plaque of non-calcified plaque group contained more fiber and fiber lipid than calcified plaque group,it was statistically significant difference.Compared with non-calcified plaque group,the mixed plaque group and calcified plaque group contained more necrotic core.Conclusion It is demonstrated that 64-MSCT have a great potential to detect coronary atherosclerotic plaque in patients,the results of 64-MSCT and IVUS are relevant.