128层螺旋CT对冠状动脉搭桥术后桥血管病变的诊断研究

Diagnostic value of 128-slice spiral CT angiography for bypass grafts in patients after coronary artery bypass grafting

目的探讨应用128层螺旋CT对冠状动脉旁路移植手术（CABG）术后桥血管病变的诊断价值。方法对46例CABG术后（术后12～76个月）的患者行128层螺旋CT造影（MSCTA）检查，共检查133条桥血管，其中乳内动脉44条，大隐静脉89条。MSCTA检查后3～10d再行冠状动脉造影（CAG）检查，结果与MSCTA检查结果进行比较。结果在133条桥血管中，MSCTA显示桥血管闭塞17条，桥血管狭窄（狭窄〉50％）20条。CAG结果显示桥血管闭塞17条，与MSCTA显示结果一致；桥血管狭窄（〉50％）有21条；与MSCTA检查结果比较，MSCTA检查结果假阳性1例，假阴性2例。计算MSCTA检查的敏感性为94．7％，特异性98．9％，阳性预测值97．3％，阴性预测值97．9％。结论128层MSCTA检查可以比较准确地判断CABG术后桥血管的病变情况，是评价CABG术后桥血管病变的一种较好的无创伤检查方法。

Objective To evaluate the diagnostic value of 128-slice spiral CT angiography（MSCTA） for bypass grafts in patients after coronary artery bypass grafting（CABG）. Methods One hundred and thirty-three bypass grafts（44 IMA grafts,89 saphenous veins grafts）of 46 patients after CABAG operation for 12 to 76 months were examined by MSCTA. Then the coronary angiography（CAG） was performed on those patients 3 -10 days after MSCTA examination. The MSCTA results were compared with the angiography results. Results Among the 133 bypass grafts, MACTA examination showed that 17 grafts were occluded and 20 grafts were severe restenosis（restenosis degree 〉 50% ）. There was also 17 occluded grafts showed in CAG examination as in MSCTA results. But 21 restenosis （ restenosis degree 〉 50% ） bypass grafts were identified by CAG. Compared with the CAG results, there was 1 false positive and 2 false negative in the MSCTA results. The overall sensitivity and specificity of MSCTA on evaluating the bypass grafts were 94. 7% and 98. 9%. The positive predictive value and the negative predictive value were 97. 3% and 97. 9%, respectively. Conclusion As a noninvasive examination, 128-slice spiral CT could accurately identify and evaluate the bypass grafts lesions after CABG.