64排螺旋CT在高龄老年冠心病患者诊断中的应用探讨

Clinical application of 64 rows spiral computed tomography in detecting coronary artery disease of advanced senile patients

目的 与导管法冠状动脉造影（CAG）对照,探讨64排螺旋CT冠状动脉成像（冠脉CTA）在高龄老年冠心病诊断中的临床应用价值.方法 本文就81例临床拟诊冠心病患者,在2周内分别行冠脉CTA及CAG检查,对冠脉狭窄情况进行评价.结果 研究对象共205例,年龄70～88岁,PCI术后20例、CABG术后6例、胸腹动脉瘤5例、周围动脉狭窄或闭塞28例,其中81例冠脉CTA和CAG同时进行,共成像血管256支.CAG显示狭窄75支：RCA 20支、LM 2支、LAD 42支、LCX 9支、桥支2支.冠脉CTA显示狭窄102支：RCA 28支、LM 6支、LAD50支、LCX 15支、桥支3支.CAG与冠脉CTA成像显示一致的58支,敏感性77％,特异性85％,阳性预测值57％,阴性预测值78％.结论 64排螺旋CT冠脉成像可作为冠脉狭窄常用及有效的无创检查之一.本组研究对象敏感性及特异性较低,分析与高龄老年冠心病患者之特点有关.

Objective To evaluate the application and clinical value of 64 rows spiral computed tomography in advanced senile patients with coronary artery disease（CAD）in comparison with invasive coronary angiography. Methods A total of 81 patients with CAD and suspected of CAD underwent 64 rows SCT within two weeks.CAG as gold standard for stenosis detection. Results In the 256 branches coronary artery of 81 patients,64 rows SCT showed 102 branches with stenosis. 50 in LAD, 15 in LCX, 6 in LMA, 28 in RCA, 3 in Bridge. CAG showed 75 branches with stenosis. 42 in LAD, 9 in LCX, 2 in LMA, 20 in RCA, 2 in Bridge. 58 branches with stenosis were displayed both 64 rows SCT and CAG. These value coresponded to a sensitivity of 77%, specifility of 85%, positive pre-dictive value 57%. and negative predictive value of 78%. Conclusion The 64 rows SCT coronary angiography shows good diagnostic accuracy with coro- nary lumen lesion detection, it may become an alternative diagnostic approach in patients with known or suspected coronary artery disease. But, in advanced senile patients are difference.