经静脉电子束CT冠状动脉造影的临床应用

Clinical application of electron beam computed tomography in intravenous three-dimensional coronary angiography

目的 探讨经静脉电子束CT(EBCT)冠状动脉造影的临床应用价值。方法 同期行选择性冠状动脉造影和EBCT冠状动脉造影检查的患者 3 8例 ,对照选择性冠状动脉造影的结果计算EBCT造影诊断冠心病和冠状动脉狭窄的准确性。结果 (1)EBCT造影可清晰显示和评价共 3 8例15 2支心外膜冠状动脉中的 13 4支 (88 2 % ) ,另 18支 (11 8% )显影不清。左主干全部清晰显示 ,左前降支、左回旋支和右冠状动脉显影清晰者分别为 94 7%、81 6%和 76 3 % ,左主干和前降支显示的比例高于左回旋支和右冠状动脉 ,统计学上差异有显著性意义 (P <0 0 5 ) ;(2 )EBCT造影诊断冠心病的敏感度、特异度、准确度、阳性和阴性预测值分别为 88 0 %、84 6%、86 8%、91 7%和 78 6% ;(3 )在3 8支腔径狭窄≥ 5 0 %的血管中 ,EBCT造影低估了其中 8支的病变程度 ,敏感度为 78 9% ;在 96支无明显狭窄的血管中 ,EBCT造影高估了其中 7支的病变程度 ,特异度为 92 7%。结论 经静脉EBCT冠状动脉造影是 1种很有价值的无创性诊断冠心病的方法 。

Objective To investigate the clinical application of intravenous three dimensional coronary angiography using electron beam computed tomography (EBCT) as compared with selective coronary angiography Methods Intravenous EBCT and selective coronary angiography were performed during the same period in 38 patients The value of EBCT angiography for diagnosing coronary artery disease was evaluated Results The number of coronary arteries adequately evaluated by EBCT angiography was 134 out of 152 vessels (88 2%), including 100% of the left main coronary arteries, 94 7% of the left anterior descending arteries, 81 6% of the left circumflex arteries and 76 3% of the right coronary arteries Significantly more left main and left anterior descending coronary arteries were adequately visualized than the left circumflex and right coronary arteries ( P <0 05) The sensitivity, specificity, accuracy, and positive and negative predictive value of EBCT angiography for diagnosing coronary artery disease were 88 0%, 84 6%, 86 8%, 91 7%, and 78 6%, respectively Of the 38 arteries with ≥50% stenosis, EBCT underestimated 8, for a sensitivity of 78 9% Of the 96 arteries without significant stenosis, EBCT overestimated 7 stenosis, for a specificity of 92 7% Conclusion Intravenous electron beam computed tomographic coronary angiography is a promising noninvasive method for diagnosing coronary artery disease