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目的:分析16层螺旋CT血管造影(MSCTA)无创性评价冠状动脉(冠脉)狭窄的价值。方法:80例临床初诊疑为冠心病,既往无冠脉成形术和搭桥术史的患者,行冠脉16层MSCTA后(其中9例在CT扫描前心率超过80次/min的患者应用了β受体阻滞剂),回顾性重建心电门控轴位图像,并分别采用容积成像、多平面重建、曲面重建、最大密度投影等后处理方法,对所有冠脉及其分支进行重建,统计可供临床评价的、管径≥1.5mm的冠脉段,以选择性冠脉造影(SCA)为标准,对比分析MSCTA诊断冠脉显著性狭窄(管腔平均直径缩小>50%)的准确性。结果:94%(989/1056)的冠脉节段和94%(290/310)的冠脉主支可供评价,(6%)67/1056段不能评价的主要原因分别为:心脏运动伪影39段,致密钙化20段和管腔显影不良8段。除外不能评价的冠脉,按节段和主支分类,与SCA相比,MSCTA诊断冠脉显著性狭窄的差异无统计学意义,其敏感性、特异性、阳性和阴性预期值分别为93%、99%、87%、99%和95%、98%、91%及99%。结论:在患者心率<80次/min时,16层MSCTA即可获得较好的图像质量用于评价冠脉并判断其狭窄程度,是一种值得临床医生信赖的检查冠脉有无狭窄的无创伤性方法。
Objective: To evaluate the value of noninvasive evaluation of coronary artery (coronary artery) stenosis by 16-slice spiral CT angiography (MSCTA). Methods: Totally 80 patients with newly diagnosed coronary heart disease were enrolled in this study. Before coronary angioplasty and bypass surgery, patients undergoing 16-slice coronary angioplasty were retrospectively analyzed. Among them, 9 patients who had a heart rate greater than 80 beats / min before CT scan had β Receptor blockers) were retrospectively reconstructed ECG-gated axial images, and all the coronary arteries and their branches were reconstructed using volume imaging, multiplanar reconstruction, surface reconstruction, maximum density projection and other post-treatment methods. Statistics For the clinical evaluation of the coronary artery with diameter ≥1.5mm, the accuracy of MSCTA in the diagnosis of coronary stenosis (> 50% lumen diameter reduction) was analyzed by selective coronary angiography (SCA) . RESULTS: Ninety-four percent (989/1056) of the coronary segments and 94% (290/310) of the major coronary arteries were available for evaluation. The main reasons for the 67/1056 non-evaluation were (6%) cardiac arrest Shadow 39, dense calcification 20 segments and lumen dysplasia 8 segments. Excluding coronary arteries, which can not be evaluated, were classified by segment and main branch. Compared with SCA, there was no significant difference in diagnosis of significant coronary stenosis by MSCTA. The sensitivity, specificity, positive and negative predictive values were 93% , 99%, 87%, 99% and 95%, 98%, 91% and 99%. Conclusion: 16-slice MSCTA can obtain better image quality when the patient’s heart rate is less than 80 beats / min, which is used to evaluate the coronary artery and determine the degree of stenosis. It is worth the clinician’s trust to check whether the coronary artery has stenosis Traumatic method.