64排MSCT诊断冠状动脉狭窄的准确性及影响因素(1)
【摘要】 目的 评价64层MSCT诊断具有血流动力学意义的冠状动脉狭窄(50%)的准确性，并分析其影响因素。方法 对48例临床高度可疑冠心病的患者行64层MSCT冠状动脉成像。扫描结束后对原始图像进行20-90期相重建，间隔10%，筛选出最佳图像用于后处理。在工作站上完成MPR、MIP、VR-TREE等多种成像方式显示冠脉。每条血管都从多个方位进行分析，特别是开口和分叉部位。选取狭窄程度最重的角度进行测量，狭窄大于50%的病灶为有临床意义病灶，检查结果与同期导管法冠脉造影对照。结果 在48例600段血管中(不包含严重钙化血管24段)，CAG显示有明显血流动力学改变的狭窄段93处(狭窄>50%)。CTA正确诊断84处，漏诊9处(其中右冠中、远段5处，回旋支远段1处，局部有严重运动伪影，前降支分叉部1处，远端1处，对角支开口1处)，假阳性8处(4处位于右冠、回旋支和前降支远端，局部血管显影密度低，4处位于右冠远段和前降支中段，搏动伪影)。在严重钙化的24段血管中CAG发现有血流动力学改变的狭窄6处。CTA正确诊断5处，漏诊1处，假阳性6处。64层MSCT诊断无严重钙化血管狭窄(50%)的敏感性、特异性、阳性预测值和阴性预测值分别为90.3%、98.6%、91.3%和98.5%。诊断严重钙化血管中度以上狭窄的敏感性、特异性、阳性预测值和阴性预测值分别为83%、75%、45.5%和75%。结论 64层MSCT对无严重钙化的冠状动脉狭窄(50%)有很高的敏感性和特异性，在诸多影响因素中，严重钙化影响最大，可高估狭窄程度。
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【关键词】冠状动脉；断层摄影术；X线计算机；血管造影术
The accuracy and influencing factors of 64-multislice spiral computed tomography for diagnosing Coronary artery stenosis
Qi Jun-hua,Yu Shu-jing，Li Zhong-xin，et al.Department of CT room，Cangzhou center hospital，Medical College of Hebei Medical University.Cangzhou 061001，China
【Abstract】 Objective To evaluate the accuracy and analyse the influencing factors of 64-multislice spiral computed tomography(MSCT)coronary angiography for diagnosing coronary artery stenosis in the patients with chest pain suspected of coronary heart disease.Methods 64-MSCT coronary angiography were performed in 48 patients suspected of coronary heart disease.Images were reconstructed at 20%-90% of the cardiac cycle in increments of 10%.Selected the best images for postprocessing.Coronary arteries were displayed by MPR，MIP and VR-TREE image formations in the workstation.Every vessel was analyzed from multidirection，especially at ostial and bifurcational sections.Stenosis degree was calibrated at the optimal position，those more than 50 percent were regard as clinical significant stenosis lesions.The results were compared with the coronary lesions of angiography.Results In 600 vessels of 48 patients，93 segments showed significant stenosis by CAG.84 segments were diagnosed correctly by CTA，9 segments were missed(5 at middle-distal segment of RCA，1 at distal segment of LCX，1 at bifurcation of LAD，1 at distal segment of LAD，1 at ostial segment of diagonal branch)， 8segments were false positive(4 at distal segment of RCA and middle segment of LAD).6 stenosis segments in twenty-four severely calcified vessels were displayed by CAG.5 segments were diagnosed correctly by CTA， 1 segment was missed，6 segments were false positive.The sensibility，specificity，positive predictive value and negative predictive value to diagnose under-middle-calcified vessels by 64 MSCT were 90.3%,98.6%,91.3% and 98.5%.The sensibility，specificity，positive predictive value and negative predictive value to diagnose above-middle-calcified vessels by 64 MSCT were 83%，75%，45.5% and 75%.Conclusion 64 MSCT has distinguished sensibility and specificity to under-middle-calcified coronary artery stenosis.Among all of influencing factors，severe-calcification is the most notable factor，it can overestimate stenosis degree.64 MSCT technology can accurately evaluate the coronary artery diseasein the patients with chest pain suspected of coronary heart disease, 百拇医药(祁俊华 于淑靖 李忠信 马国军 赵炳朕)
, http://www.100md.com
【关键词】冠状动脉；断层摄影术；X线计算机；血管造影术
The accuracy and influencing factors of 64-multislice spiral computed tomography for diagnosing Coronary artery stenosis
Qi Jun-hua,Yu Shu-jing，Li Zhong-xin，et al.Department of CT room，Cangzhou center hospital，Medical College of Hebei Medical University.Cangzhou 061001，China
【Abstract】 Objective To evaluate the accuracy and analyse the influencing factors of 64-multislice spiral computed tomography(MSCT)coronary angiography for diagnosing coronary artery stenosis in the patients with chest pain suspected of coronary heart disease.Methods 64-MSCT coronary angiography were performed in 48 patients suspected of coronary heart disease.Images were reconstructed at 20%-90% of the cardiac cycle in increments of 10%.Selected the best images for postprocessing.Coronary arteries were displayed by MPR，MIP and VR-TREE image formations in the workstation.Every vessel was analyzed from multidirection，especially at ostial and bifurcational sections.Stenosis degree was calibrated at the optimal position，those more than 50 percent were regard as clinical significant stenosis lesions.The results were compared with the coronary lesions of angiography.Results In 600 vessels of 48 patients，93 segments showed significant stenosis by CAG.84 segments were diagnosed correctly by CTA，9 segments were missed(5 at middle-distal segment of RCA，1 at distal segment of LCX，1 at bifurcation of LAD，1 at distal segment of LAD，1 at ostial segment of diagonal branch)， 8segments were false positive(4 at distal segment of RCA and middle segment of LAD).6 stenosis segments in twenty-four severely calcified vessels were displayed by CAG.5 segments were diagnosed correctly by CTA， 1 segment was missed，6 segments were false positive.The sensibility，specificity，positive predictive value and negative predictive value to diagnose under-middle-calcified vessels by 64 MSCT were 90.3%,98.6%,91.3% and 98.5%.The sensibility，specificity，positive predictive value and negative predictive value to diagnose above-middle-calcified vessels by 64 MSCT were 83%，75%，45.5% and 75%.Conclusion 64 MSCT has distinguished sensibility and specificity to under-middle-calcified coronary artery stenosis.Among all of influencing factors，severe-calcification is the most notable factor，it can overestimate stenosis degree.64 MSCT technology can accurately evaluate the coronary artery diseasein the patients with chest pain suspected of coronary heart disease, 百拇医药(祁俊华 于淑靖 李忠信 马国军 赵炳朕)