支架置入术后64排螺旋CT冠状动脉图像影响因素初步探讨

  本文关键词：支架置入术后64排螺旋CT冠状动脉图像影响因素初步探讨，由笔耕文化传播整理发布。

        目的探讨不同因素影响下64排螺旋CT冠状动脉成像对冠状动脉支架置入术后随访评估的可靠性。方法对我科2009年8月至2013年10月间129例冠状动脉支架置入术患者进行64排螺旋CT冠状动脉成像，根据对比剂注射速率、对比剂浓度、支架直径、支架材料、冠状动脉支架置入血管解剖位置不同分别进行研究：观察对比剂注射速率、对比剂浓度、支架直径、支架材料、支架置入的解剖位置对64排螺旋CT冠状动脉支架显影图像质量的影响。支架显影质量指标：支架置入位置有无移位、支架内部结构显影是否清晰、支架内及支架附近血管通畅情况及远侧血管显影状况。25例患者48枚支架冠状动脉CT重建图像以冠状动脉造影为标准进行对比参照，了解64排螺旋CT评估冠状动脉支架通畅性的准确性和可靠性。结果在不同因素影响下分别观察，患者其它因素无统计学差异：对比剂注射速率为4.5ml/s支架图像显影评估3分及3分以上占所观察支架比例为91.4%，与4.0ml/s及3.5ml/s组比较有统计学差异（χ2=5.106，P=0.024和χ2=4.188，P=0.041）；浓度为370mg I/ml对比剂支架显影在3分及3分以上所占支架比例为90.9%，浓度为350mg I/ml对比剂支架显影在3分及3分以上所占比例为90%，均优于对比剂浓度320mg I/ml支架图像质量,与浓度为320mg I/ml比较，其统计学上有差异（χ2=4.694， P=0.030与χ2=3.955,P=0.047）。支架直径≥4.0mm组CT重建图像3分及3分以上的支架占支架总数比例92.7%；支架直径在3.0～4.0mm之间CT重建图像3分及3分以上支架占支架总数的83.3%；与支架直径在2.25mm～3.0mm之间CT冠状动脉成像比较，，其统计学上有显著性差异（χ2=9.939，P=0.002与χ2=6.959,P=0.008）；左主干冠脉CT支架重建图像3分及3分以上占支架总数比例为90.2%；前降支支架冠脉CT支架重建3分及3分以上占支架总数比例为86.4%。统计学处理显示左主干和前降支内支架CT成像质量与回旋支和右冠脉比较，有统计学差异，分别为χ2=8.024，P=0.005；χ2=5.902，P=0.015与χ2=7.550,P=0.006；χ2=5.515，P=0.019。药物涂层支架CT重建支架图像质量在3分及3分以上占支架总数的86.4%。统计学处理显示药物涂层支架成像质量好于金属裸支架（χ2=8.111，P=0.004）。以冠状动脉造影检查结果为标准，64排螺旋CT支架重建对于支架闭塞诊断的敏感性为100%，准确性为100%。对于闭塞加狭窄（支架狭窄程度大于50%）诊断的敏感性为90%，假阴性为10%，阳性预测值为100%，64排螺旋CT支架重建图像对支架狭窄（＞50%）和闭塞的诊断与冠状动脉造影比较，无统计学差异（χ2=0.057，P=0.811）。结论1.对于支架置入术后病例支架通畅性评估中，排除其它因素影响下，对比剂注射速率为4.5ml/s支架显影图像质量优于对比剂注射速率为4.0ml/s、3.5ml/s；对比剂浓度370mg I/ml、350mg I/ml支架显影图像质量略优于对比剂浓度320mg I/ml支架显影图像。2.对于支架置入术后病例支架通畅性评估中，排除其它因素影响下：支架直径大于3.0mm冠状动脉重建支架图像明显优于支架直径小于3.0mm，且支架直径越大，支架图像越清晰；支架置入在左主干和前降支冠脉重建图像质量优于支架置入在回旋支和右冠脉支架；药物涂层支架64排螺旋CT冠状动脉成像质量明显优于金属裸支架。3.64排螺旋CT冠状动脉成像与传统的冠状动脉造影相比，具有创伤小、费用低等优势。基本可达到冠状动脉造影相近的支架显影清晰度和支架通畅性评估准确性的要求。总之，64排螺旋CT冠状动脉成像在支架置入术后支架通畅性评估具有较高的准确性、可靠性，是一种安全、有效、更加微创的影像学检查手段，值得推广。

    Objective: To assess the clinical value of64-slice spiral computed tomography coronaryangiography in post coronary stenting follow up with different factors.Methods:129Patients after stent implantation were examined with64-Slice ComputedTomography Angiography from August2009to October2013. The contrastmedium, thecontrast concentration, the diameter of the stent, the scaffold material and theanatomic location of stent implantation were evaluated so as to analyze their effects on the imagequality of64-slice computed tomography angiography. The image quality standards of coronaryartery stent include the anatomical position, the clarity of the internal structure, the condition ofthe flow and the distal angiography. Compared with coronary angiogram image, some imageswere reconstructed to evaluate the accuracy and reliability of using64-slice spiral computedtomography coronary angiography.Results: There was no significant difference in the other different factors. The percentageof3scores and above3(the score on coronary artery stent image evaluation with the injection speed4.5ml/s) took91.4%.It had statistic difference between the group4.5ml/s andthe groups4.0ml/s and3.5ml/s（χ2=5.106，P=0.024和χ2=4.188，P=0.04).The percentage of3scores and above3(the score on coronary artery stent image evaluation with370mg I/mldosage of contrast medium) took90.9%and the percentage of that with350mg I/ml dosageof contrast medium took90%. They were superior to the stent image quality with320mg/mldosage of contrast medium. There was significant difference between370mg I/ml/350mg I/mldosage of contrast medium and320mg/ml dosage of contrast medium（χ2=4.694，P=0.030与χ2=3.955,P=0.047）.The percentage of the image reconstructions3scores and above3with the stent diametergreater than4mm took92.7%. The percentage of that with the stent diameter between3.0mmand4mm took83.3%. It had statistic difference between the stent diameter greater than4mm(thestent diameter between3.0mm and4mm) and the stent diameter between2.25mm and3.0mm（χ2=9.939，P=0.002与χ2=6.959,P=0.008）. The percentage of3scores and above3(the scoreon coronary artery stent image evaluation with the left main coronary artery) took90.2%. Thepercentage of3scores and above3(the score on coronary artery stent image evaluation withanterior descending) took86.4%. There were significant differences between the left maincoronary artery (anterior descending) and circumflex coronary artery (right coronary artery)(χ2=8.024，P=0.005；χ2=5.902，P=0.015与χ2=7.550,P=0.006；χ2=5.515，P=0.019). Thepercentage of3scores and above3(the score on coronary artery stent image evaluation withdrug-eluting stents) took86.4%. The statistic difference showed that the image quality withdrug-eluting stents were better than that with bare metal stents（χ2=8.111，P=0.004）.Based on the results of coronary angiography, the sensibility of diagnosing stent occlusionwas100%and the accuracy100%. The sensibility of diagnosing occlusion and stenosis (Thedegree of stent stenosis greater than50%) was90%. The false negative rate was10%. Thepositive predictive value was100%. There were no significant differences between the results ofocclusion and stenosis (greater than50%) and the results of coronary angiography （χ2=0.057，P=0.811）. Conclusions:1. The image quality of coronary artery stent with injection speed4.5ml/s is better than thatbased on injection speed4.0ml/s and3.5ml/s. The image quality of coronary artery stent with400mg/ml and370mg/ml dosage of contrast medium is superior to that with350mg/ml dosageof contrast medium.2. The image quality of64-slice spiral computed tomography coronary angiographycombined with reconstruction technique with stent diameter greater than3mm is better than thatwith diameter less than3mm. The image quality of64-slice CT angiography combined withreconstruction technique on coronary artery with stenting in the left main coronary artery andanterior descending is superior to that with stenting in circumflex coronary artery and rightcoronary artery. The image quality with biodegradable stents is better than that with bare metalstent and drug-eluting stents.3. Compared with traditional coronary artery,64-slice spiral computed tomographycoronary angiography is safer, less expensive and clearer.In a word, using64-slice spiral computed tomography coronary angiography in post coronarystenting follow up is with high accuracy and reliability. It is a safe, effective andminimally-invasive imaging examination and is worth recommending.

支架置入术后64排螺旋CT冠状动脉图像影响因素初步探讨

英文缩略词表5-6中文摘要6-9Abstract9-111. 前言13-142. 材料与方法14-183. 结果18-284. 讨论28-365. 结论36-376．下一步研究方向37-387. 参考文献38-41综述41-52    参考文献50-52

  本文关键词：支架置入术后64排螺旋CT冠状动脉图像影响因素初步探讨，由笔耕文化传播整理发布。