冠状动脉MSCTA成像在冠心病诊断中的应用

Application of MSCT angiography to diagnosis of coronary artery disease

目的评价多层螺旋CT冠状动脉成像对冠心病病变的临床诊断价值。方法对57例临床初诊或可疑冠心病患者行多层螺旋CT冠状动脉成像(MSCTA),并且与常规冠状动脉造影(CAG)做对照分析。结果 57例患者的228支冠脉分支中,冠脉CTA成像检出病变冠脉213支(93.4%),MSCTA诊断冠状动脉血管狭窄≥50%的均有较高的灵敏度、特异度、阳性预测值、阴性预测值和准确度,分别为88%、99%、91%、98%和99%。钙化斑块组的CT值(415.2±221.1)HU明显高于非钙化斑块的CT值(68.4±47.5)HU(P<0.01)。结论 MSCTA对显示有临床意义的冠状动脉狭窄(≥50%)具有优良诊断价值,几乎可以代替有严重并发症的冠状动脉造影,能够结合密度测定判定斑块的性质,对判断冠脉斑块的稳定性具有重要的临床意义,是安全、准确、可靠的冠心病诊断方法。

Objective To evaluate the value of multislice spiral CT （MSCT） coronary angiography for the diagnosis of coronary heart disease （CHD）. Methods A total of 57 patients with newly diagnosed or suspected CHD underwent MSCT coronary angiography （MSCTA） , and also underwent conventional coronary angiography （CAG） as control. Results In the 228 coronary segments of the 57 patients, 213 （93.4%） were satisfying to be evaluated by MSCTA. The global sensitivity （ coronary artery stenosis 〉50% ） , specificity, positive predictive value, negative predictive value and accuracy were 88% , 99% , 91% , 98% and 99% , respectively. The CT density of the group of calcified plaques （415.2 _＋ 221.1 ） HU were significantly higher than that of non-calcl- fied plaques （68.4 -＋ 47.5） HU （P 〈 0.01 ）. Conclusion MSCTA, almost in place of CAG in clinical practice, is of excellent value in the diagnosis of significant coronary stenosis （ I〉50% ） , by which the character of the plaque is able to be assessed. It is a safe, accurate and reliable method to the diagnosis of CHD.