320排动态容积CT冠状动脉成像诊断冠心病的初步应用

Preliminary application of 320-detector row dynamic volume CT angiography in diagnosing coronary heart diseases

目的探讨320排动态容积CT冠状动脉成像(CTA)诊断冠心病的准确性。方法 2010年3月至2010年9月对临床拟诊为冠心病的82例患者先后行冠状动脉CTA及冠状动脉造影(ICA)检查,并以ICA为金标准,评估320排CTA诊断冠状动脉狭窄≥50%及≥70%的敏感度、特异度、阳性预测值及阴性预测值。结果 CTA成像质量4分71例(86.6%),平均心率为67次/min;3分10例(12.2%),平均心率为74次/min;2分1例(1.2%),心率为83次/min;1分0例,全部病例均无阶梯伪影。CTA发现174个狭窄≥50%的节段,ICA发现144个以ICA为金标准,320排CTA诊断狭窄≥50%的敏感度、特异度、阳性预测值及阴性预测值分别为93.1%、96.0%、77.0%和99.0%。CTA发现40个狭窄≥70%的节段,ICA发现40个。以ICA为金标准,320排CTA诊断狭窄≥70%的敏感度、特异度、阳性预测值及阴性预测值分别为100%、95.6%、45.5%和100%。结论 320排CTA图像质量好,诊断冠心病准确可靠。

Objective To evaluate the diagnostic accuracy of 320-detector row dynamic volume CT angiography （CTA） for coronary heart diseases. Methods During the period from March 2010 to Sepo 2010, a total 82 consecutive patients suspected of having coronary heart diseases were enrolled in this study. CTA with a 320-detector row CT unit and invasive coronary angiography （ICA） were performed in all patients to clarify the diagnosis. Taking ICA as gold standard, the sensitivity, specificity, positive predictive value （PPV） and negative predictive value （NPV） of ≥ 50% and ≥ 70% luminal stenosis obtained from 320- detector row dynamic volume CTA were evaluated. The results were analyzed. Results On CTA, exceUent image quality （score of g） was obtained in 71 cases （86.6%） with an average heart rate of 67 bpm. Good image quality （score of 3） was seen in 10 cases （12.2%） with an average heart rate of 74 bpm, while acceptable image quality （score of 2） was seen only in 1 case （1.2%） with an average heart rate of 83 bpm. No unacceptable image quality （score of 1 ） was found. No stair-step artifact was found in all cases. A total of 174 segments with ~ 50% luminal stenosis were demonstrated on CTA,while a total of 144 segments with ≥ 50% luminal stenosis were shown on ICA. Using ICA as gold standard, the sensitivity, specificity, PPV and NPV of ≥ 50% luminal stenosis on CTA were 93.1%, 96.0%, 77.0% and 99.0%, respectively. CTA discovered 40 segments having ≥ 70% luminal stenosis, and ICA also revealed 40 segments with ~ 70% luminal stenosis. With ICA as gold standard, the sensitivity, specificity, PPV and NPV of ≥ 70% luminal stenosis on CTA were 100%, 95.6%, 45.5% and 100%, respectively. Conclusion Dynamic volume CTcoronary angiography with a 320- detector row CT unit can provide high quality images as well as a precise and reliable diagnosis for coronary heartdiseases.