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目的比较16层螺旋CT(16multi detectorCT,16MDCT)冠状动脉血管造影(CTA)和三维屏气冠状动脉MR血管造影(MRA)的图像质量以及诊断冠状动脉显著性狭窄(>50%)的准确性。方法40例疑有冠心病患者在3d内均行冠状动脉CTA和MRA检查,其中31例患者在2周内行冠状动脉造影检查。将冠状动脉分成9个节段(右冠状动脉近、中、远段,左冠状动脉主干,前降支近、中、远段和旋支近、远段),由2名影像科医生共同对各个节段的图像质量按0～4级评分,比较CTA和MRA上各个节段的图像质量。以冠状动脉造影为标准,计算并比较CTA和MRA诊断31例冠状动脉显著性狭窄(>50%)各项准确性指标。结果CTA在右冠状动脉中段的图像质量低于MRA,右冠状动脉近段二者无区别,其他节段均优于MRA。冠状动脉造影显示31例患者共有43个节段狭窄>50%,CTA和MRA分别正确诊断出36和27个,其敏感性、特异性、阳性预测值和阴性预测值分别为83%、84%、49%、97%和63%、90%、55%、93%。结论除右冠状动脉中段,CTA大部分节段的图像质量优于MRA。CTA诊断冠状动脉显著性狭窄的敏感性高于MRA,但特异性低于MRA。冠状动脉CTA和MRA均表现了较高的阴性预测值,对排除冠状动脉狭窄具有临床价值。
Objective To compare the image quality of 16-slice multi-detector CT (16MDCT) coronary angiography (CTA) and three-dimensional breath-hold coronary MR angiography (MRA) and the accuracy of diagnosing significant coronary stenosis (> 50%). Methods 40 cases of suspected coronary heart disease patients underwent coronary CTA and MRA within 3 days, of which 31 patients underwent coronary angiography within 2 weeks. Coronary arteries were divided into 9 segments (proximal, middle and distal segments of the right coronary artery, trunk of the left coronary artery, proximal descending artery, middle and distal segments, proximal and distal segments of the circumflex artery) The image quality of each segment was graded from 0 to 4 and the image quality of each segment on the CTA and MRA was compared. To coronary angiography as the standard, calculate and compare CTA and MRA diagnosis of 31 cases of significant coronary stenosis (> 50%) accuracy of the indicators. Results The image quality of CTA in the middle part of the right coronary artery was lower than MRA. There was no difference between the two groups in the right coronary artery. The other segments were superior to MRA. Coronary angiography showed a total of 43 segments in 31 patients with stenosis> 50%. CTA and MRA correctly diagnosed 36 and 27, respectively. The sensitivity, specificity, positive predictive value and negative predictive value were 83%, 84% , 49%, 97% and 63%, 90%, 55% and 93% respectively. Conclusion The image quality of most segments of CTA is better than that of MRA except for the middle right coronary artery. CTA diagnosis of significant coronary stenosis is more sensitive than MRA, but less specific than MRA. Coronary CTA and MRA showed a higher negative predictive value for the exclusion of coronary artery stenosis has clinical value.