CT和MRI在冠状动脉疾病诊断中的应用比较

The comparison of MRI and CT in the diagnosis of coronary disease

目的比较心脏计算机断层扫描(CT)和心脏磁共振成像(MRI)在冠状动脉疾病的诊断的应用方法。方法 2008年2月到2010年2月我们前瞻性的连续选择了94例已知或者疑似CAD的患者,进行MRI心肌灌注、传统的冠状动脉造影、前瞻性ECG-门控的冠脉CTA分析,并比较了MRI心肌灌注和CA、前瞻性ECG-门控冠脉CTA加MRI心肌灌注和CA;评估了血流动力学相关狭窄。结果 MRI心肌灌注揭示了60/94(63.8%)的人具有心肌缺损(灌注缺损或梗阻)。CA揭示了94例病人中有66例冠状动脉中有150例大于50%直径的狭窄。平均每名患者的有效辐射剂量为2.5±1.1mSv。检测冠状动脉狭窄大于50%,在CA的敏感性,特异性,NPV,PPV和准确率低于MRI心肌灌注以及冠脉CTA加MRI心肌灌注。其中1例病人在CD伴随着MRI心肌灌注的LAD灌注缺损,在冠脉CTA被判定为没有明显狭窄。结论在诊断血流动力学相关的CAD,冠状动脉CTA可能取代CA。

Objective To compare the application method of CT and MRI in the diagnosis of coronary disease.Methods MRI myocardial perfusion,traditional coronary angiography and prospective ECG-gated coronary CTA of 94 cases with or suspected with CAD from Feb.2008 to Feb.2008 were analyzed and compared with that added MRI myocardial perfusion and CA,and hemodynamics stenosis was evaluated.Results MRI myocardial perfusion showed that 60/94（63.8%） has myocardial defect（perfusion defect or obstruction）.CA showed that in 94 cases,66 had stenosis in coronary artery,where is bigger than 50% diameter.The average effective radiation dose was 2.5±1.1 mSv.Coronary stenosis was more than 50%.The sensitivity and specificity of CA,NPV,PPV and accuracy rate were lower than MRI myocardial perfusion and coronary CTA added MRI myocardial perfusion.Among them,1 case complicated with LAD perfusion defect in CD,but showed no obvious stenosis in coronary CTA.Conclusion In the diagnosis of CAD,coronary CTA may be possible to substitute CA.