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目的对比分析双源CT(dual-source CT,DSCT)与冠状动脉造影(coronary angiography,CAG)评估支架内再狭窄(in stent restenosis,ISR)的结果,探讨支架所在部位及支架大小对DSCT评估冠状动脉ISR的影响。方法 106例同期行DSCT及SCAG检查的支架术后的患者,以SCAG结果为标准,比较DSCT评估不同部位及大小支架ISR的敏感性、特异性及准确性。结果 173枚支架中有156枚支架DSCT显影良好。DSCT显示有ISR的支架33枚,CAG证实存在ISR的支架38枚,DSCT诊断ISR的敏感度和特异度分别为78.9%和97.5%,阳性预测值90.9%,阴性预测值93.5%,一致率为92.9%。DSCT对近心端支架再狭窄的检出率优于远心端支架;直径≥3.0 mm支架的ISR检出率优于直径<3.0 mm支架。结论支架内径大小及所在部位影响DSCT图像的显示。DSCT在评估ISR方面,可基本取代SCAG作为冠脉近端支架及大直径支架(支架直径≥3 mm)通畅情况的评估方式。
Objective To compare and analyze the results of dual-source CT (DSCT) and coronary angiography (CAG) in assessing in-stent restenosis (ISR) and to explore the location of the stent and the size of the stent in assessing the coronary Effect of Arterial ISR. Methods A total of 106 patients underwent DSCT and SCAG examinations in the same period underwent SCTA. The sensitivity, specificity and accuracy of DSCT in evaluating the ISR of different sites and sizes were compared. Results Of 156 stents in 173 stents, DSCT developed well. Thirty-three ISR scaffolds were screened by DSCT and thirty-eight scaffolds were confirmed by CAGS. The sensitivity and specificity of DSCT in the diagnosis of ISR were 78.9% and 97.5%, respectively, with a positive predictive value of 90.9% and a negative predictive value of 93.5% 92.9%. DSCT is superior to telecentric stents in the restenosis of proximal stents; the detection rate of ISR of stents with diameters of 3.0 mm is better than that of stents <3.0 mm in diameter. Conclusion The size of stent and its location affect the DSCT image display. In assessing ISR, DSCT can largely replace SCAG as an assessment of the patency of proximal coronary stents and large diameter stents (stent diameter ≥ 3 mm).