多层螺旋CT血管造影在评价冠状动脉粥样硬化性心脏病心肌缺血程度价值分析

Value of Multi-slice Spiral CT Angiography in Evaluating Myocardial Ischemia in Coronary Atherosclerotic Heart Disease

目的分析冠状动脉粥样硬化性心脏病心肌缺血程度应用多层螺旋CT血管造影的评价价值。方法选取2014年7月至2018年7月就诊于西电集团医院及榆林市第一医院影像科的80例疑似冠心病患者,均行MSCTA检查,以CAG检查为对照,计算MSCTA检查冠脉狭窄的准确性、敏感性、特异性,并比较CAG、MSCTA检出冠脉狭窄程度情况;再行核素M PI检查,计算M S CTA检出狭窄冠脉的心肌灌注积分差、负荷总积分。结果以CAG检查为对照,在80疑似患者中,MSCTA检查显示:68例患者存在冠脉狭窄共166支,准确性、敏感性、特异性、阳性预测值、阴性预测值分别为96.68%、97.58%、95.28%、96.99%、96.19%。MSCTA、CAG检出冠脉不同狭窄的程度比较无统计差异(P>0.05)。在MSCTA检查中,轻度狭窄组的灌注积分差(0.80±0.60)分、心肌负荷总积分(2.00±1.58)分,均比中度狭窄组、重度狭窄组低,差异显著(P<0.05)。结论MSCTA不仅能评估冠状动脉狭窄程度,判断导致冠状动脉狭窄的斑块性质,还能初步判断冠心病心肌缺血的程度,具有较高的准确性、敏感性、特异性,临床应用价值高。

Objective To analyze myocardial ischemia in patients with coronary atherosclerotic heart disease by multi-slice spiral CT angiography.Methods 80 patients with suspected co ronary artery disease in our hospital from July 2017 to July 2018 were examined by MSCTA.The accuracy,sensitivity and specificity of MSCTA in detecting coronary artery stenosis were compa red with those of CAG,and the degree of coronary artery stenosis detected by CAG and MSCTA was evaluated.Then we performed the radionuclide MPI examination to calculate the integral difference of myocardial perfusion and the total load score of stenosed coronary artery detected by MSCTA.Results Compared with CAG,MSCTA showed that there were 166 coronary stenosis in 68 suspected patients.The accuracy,sensitivity,specificity,positive predictive value and negative predictive value were 96.68%,97.58%,95.28%,96.99%and 96.19%respectively.There was no statistical difference in the degree of coronary stenosis detected by MSCTA and CAG(P>0.05).MSCTA show that the integral difference of myocardial perfusion and the total load score of mild stenosis group were(0.80±0.60)score,(2.00±1.58)score,which were significantly lower than the moderate stenosis group and severe stenosis group(P<0.05).Conclusion MSCTA can assess not only the degree of coronary artery stenosis,determine the plaque properties of coronary artery stenosis,but also the degree of myocardial ischemia preliminarily in coronary heart disease with high accuracy,sensitivity,specificity and clinical value.