We sought to compare the diagnostic value of multi-slice computed tomography(MSCT)coronary angiography(CA)to detect significant stenoses(< 50%lumen diameter reduction)-with that of invasive CA. The latest 16-row MS...We sought to compare the diagnostic value of multi-slice computed tomography(MSCT)coronary angiography(CA)to detect significant stenoses(< 50%lumen diameter reduction)-with that of invasive CA. The latest 16-row MSCT scanner has a faster rotation time(375 ms)and permits scanning with a higher X-ray tube current(500 to 600 mA)during MSCT CA when compared with previous scanners. We studied 51 patients(37 men, mean age 58.9±10.0 years)with stable angina or atypical chest pain. Patients with pre-scan heart rates < 70 beats/min received oral beta-blockade. The heart was scanned after intravenous injection of 100 ml contrast(iodine content, 400 mg/ml). Mean scan time was 18.9±1.0 s. The MSCT scans were analyzed by two observers unaware of the results of invasive angiography, and all available coronary branches< 2 mm were included. Invasive CA demonstrated normal arteries in 16%(8 of 51), non-significant disease in 21%(11 of 51), single-vessel disease in 37%(19 of 51), and multivessel disease in 26%(13 of 51)of patients. There were 64 significant lesions. Sensitivity, specificity, and positive and negative predictive values for detection of significant lesions on a segment-based analysis were 95%(61 of 64, 95%confidence interval [CI] 86 to 99), 98%(537 of 546, 95%CI 96 to 99), 87%(61 of 70, 95%CI 76 to 98), and 99%(537 of 540, 95%CI 98 to 99), respectively. All patients with angiographically normal coronary arteries or significant lesions were correctly identified. Three of 11 patients with < 50%lesions were incorrectly classified as having single-vessel disease. The 16-row MSCT CA reliably detects significant coronary stenoses in patients with atypical chest pain or stable angina pectoris.展开更多
文摘目的:探讨胸主动脉多排螺旋计算机体层扫描三维血管成像(CTA3D)的价值。方法:回顾性分析58例胸主动脉CTA3D血管成像。造影剂量按1.5～2.0ml/kg,注射速率为3ml/s。扫描延迟时间按2种方法进行:①Bolus tracking法,即造影剂跟踪扫描;②test Bolus法,即造影剂峰值测试进行时间延迟。数据重建为三维工作站用实时三维重建(Real time 3D,RT3D)及Fly3D(VR),有的亦用多平面重建法(MPR)、曲面重建法(CPR)及仿真内镜法(VE)。结果:58例中,11例正常,10例主动脉硬化,可见主动脉壁有不同程度的钙化斑。6例胸主动脉瘤和28例胸主动脉夹层动脉瘤,经MPR及RT3D等成像,均可清晰显示动脉瘤体及夹层的真假腔和破裂口。3例主动脉缩窄可显示缩窄的部位、程度和范围。结论:多排螺旋CTA3D胸主动脉成像是一种安全、无创性的检查方法,临床上值得推广应用。
文摘We sought to compare the diagnostic value of multi-slice computed tomography(MSCT)coronary angiography(CA)to detect significant stenoses(< 50%lumen diameter reduction)-with that of invasive CA. The latest 16-row MSCT scanner has a faster rotation time(375 ms)and permits scanning with a higher X-ray tube current(500 to 600 mA)during MSCT CA when compared with previous scanners. We studied 51 patients(37 men, mean age 58.9±10.0 years)with stable angina or atypical chest pain. Patients with pre-scan heart rates < 70 beats/min received oral beta-blockade. The heart was scanned after intravenous injection of 100 ml contrast(iodine content, 400 mg/ml). Mean scan time was 18.9±1.0 s. The MSCT scans were analyzed by two observers unaware of the results of invasive angiography, and all available coronary branches< 2 mm were included. Invasive CA demonstrated normal arteries in 16%(8 of 51), non-significant disease in 21%(11 of 51), single-vessel disease in 37%(19 of 51), and multivessel disease in 26%(13 of 51)of patients. There were 64 significant lesions. Sensitivity, specificity, and positive and negative predictive values for detection of significant lesions on a segment-based analysis were 95%(61 of 64, 95%confidence interval [CI] 86 to 99), 98%(537 of 546, 95%CI 96 to 99), 87%(61 of 70, 95%CI 76 to 98), and 99%(537 of 540, 95%CI 98 to 99), respectively. All patients with angiographically normal coronary arteries or significant lesions were correctly identified. Three of 11 patients with < 50%lesions were incorrectly classified as having single-vessel disease. The 16-row MSCT CA reliably detects significant coronary stenoses in patients with atypical chest pain or stable angina pectoris.
