128层螺旋CT冠状动脉造影在评估冠脉支架置入后随访中的临床应用价值

The Clinical Value of Follow-up Inspection by 128 Slices CT Coronary Angiography in Appraising the Condition after Coronary Stent implantation

目的探讨128层螺旋CT在评估冠状动脉放置支架后通畅情况的临床应用价值。方法选择63例冠状动脉置入支架术后患者,病史3～18个月。随访检查,先行128层螺旋CT增强扫描结合回顾性心电门控技术检查,检查结束后在1～2周内接受选择性冠状动脉造影进行对照。结果 128层螺旋CT血管成像检查结果显示,63例患者接受置入支架93枚,有86枚支架图像显示清楚,其中68枚支架无狭窄,18枚支架再狭窄,与选择性冠状动脉造影检查结果一致性高。敏感度:85.7%,特异度:95.8%,阳性预测值:81.8%,阴性预测值:95.8%,准确诊断指数为0.925,阳性似然比为20.41,阴性似然比为0.149,准确度为92.5%,Kappa值为0.79.结论128层螺旋CT冠状动脉造影是评价冠状动脉支架通畅或再狭窄的无创性的非常有价值的检查方法,其准确性高,能大部分取代选择性冠状动脉造影检查。

Objective To evaluate the clinical value of 128-slice spiral CT in appraising the patency after the placement of coronary stent.Methods Enhanced 128-slice spiral CT scans and retrospectively ECG-gating was performed first during the follow-up inspection to 63 patients with 3 to 18 months coronary stent implantation,then selective coronary arteriography（SCA） were taken followed 1 to 2 weeks in contrast.Results 93 stents were implanted into 63 cases of patients who have been treated with 128-slice spiral CT angiography,compared with those have been treated with SCA.86 clear CT angiography images of stents indicated that 68 stents were patency and 18 stents were in-stent restenosis,which had high correspondence with SCA.The result of sensitivity,specificity,positive predictive value,negative predictive value,accurate diagnosis is 85.7%,95.8%,81.8%,95.8%,0.925,positive and negative likelihood ratios is 20.41 and 0.149,accuracy and Kappa value is 92.5% and 0.79.Conclusion 128-slice spiral CT coronary angiography is an effective and noninvasive method to appraise the patency or restenosis after the placement of coronary stent,which could mostly replace SCA for its high accuracy.