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多层螺旋CT(multidetector spiral computed tomography,MDCT)在CAD诊断领域的主要适应证有:测定冠状动脉钙化积分(coronary artery calcium score,CACS)、CT冠状动脉造影、评价心肌功能及冠心病(coronary artery disease,CAD)在治疗后的随访。据报道,CACS用于诊断CAD的敏感性范围在68.0%～100%,特异性范围在21.0%～100%。高CACS是一个敏感性很高但特异性相对较低的指标,与常规冠状动脉造影(coronary angiography,CAG)相比,16排MDCT的冠状动脉造影在诊断冠状动脉狭窄(350%)时具有中高度敏感性和高度阴性预测值(negative predictive value,NPV)。与之相比,64排MDCT的敏感性和NPV更高,但特异性与阳性预测值(positive predictive value,PPV)却无明显提高。将冠状动脉形态学与心肌灌注功能研究相结合,是今后CAD的研究方向。
The main indications of multidetector spiral computed tomography (MDCT) in the field of CAD diagnosis include coronary artery calcium score (CACS), CT coronary angiography, myocardial function and coronary artery disease, CAD) follow-up after treatment. It has been reported that the sensitivity of CACS for the diagnosis of CAD ranges from 68.0% to 100% with a specificity range of 21.0% to 100%. High CACS is a highly sensitive but relatively low specificity indicator with 16-slice MDCT coronary angiography compared with conventional coronary angiography (CAG) at diagnosis of coronary artery stenosis (350%) Highly sensitive and negative predictive value (NPV). In contrast, 64-row MDCT had higher sensitivity and NPV but no significant increase in specificity and positive predictive value (PPV). The coronary artery morphology and myocardial perfusion function research is the future direction of CAD research.