64排CT在冠心病中的诊断价值

发布时间：2018-07-24 08:57

【摘要】：目的观察冠心病患者64排CT冠状动脉成像（64SCTCA）对冠状动脉近、中段狭窄的诊断结果，与冠状动脉造影（CAG）结果比较，分析两者结果不相同原因，评估64SCTCA对冠状动脉近中段狭窄诊断的准确性，并初步评估斑块性质。以CAG诊断结果为标准，评估64SCTCA对冠状动脉支架内再狭窄（ISR）诊断价值。材料与方法收集2011年4月至2012年12月在泰山医学院附属医院影像中心行64SCTCA的患者120例，其中临床诊断为冠心病的患者22例同时行64SCTCA和CAG检查，CT检查图像传至AW4.4后处理工作站进行处理。64SCTCA检查结果和CAG检查结果分别由两名放射科和两名心内科医师在不知道对方结果的前提下进行分析。两种方法的结果进行统计学比较。同时行64SCTCA和CAG检查的冠状动脉介入治疗（PCI）术后随访患者18例，64SCTCA检查结果和CAG检查结果分别由两名放射科和两名心内科医师在不知道对方结果的前提下进行分析。两种方法的结果进行统计学比较。结果 1、102例患者（除去PCI术后患者18例）,3例（2.9％）图像质量不能进行影像学评价。冠状动脉类型中右优势型占66.7％（67/99），均衡型占28.3％（28/99），左优势型占4.1％（4/99）。有一支对角支占27.3％（27/99），两支对角支占61.6％（61/99），超过两支的占11.1％（11/99），未发现无对角支；有一支钝缘支占30.3％（30/99），两支钝缘支占53.5％（53/99），超过两支的占16.2％（16/99），未发现无钝缘支。本实验发现11例（11.1％）患者存在心肌桥，1（1％）例患者冠状动脉瘤，1（1％）例患者冠状动脉开口发育异常。 2、99例患者行64SCTCA共检出409处粥样斑块，其中钙化斑块106处，非钙化斑块218处，混合斑块共85处，冠状动脉粥样斑块多位于LAD近中段，其次为RCA近中段和LCx近段。 3、以RCA近中段、LM、LAD近中段、LCx近段为研究对象，其中2例患者图像质量不能进行评价，20例冠心病患者可用于分析的节段为105段（87.5％）。以CAG结果为金标准，64SCTCA诊断管腔狭窄程度≥50％的敏感性为79.2％（19/24），特异性为92.6％（75/81），阳性预测值为76.0％（19/25），阴性预测值为93.8％（75/80）。两者在评价管腔狭窄程度≥50％统计学上是无明显差异的（P=0.870，P＞0.05）。 4、18例患者共植入支架35枚,32枚支架（91.4％）显影良好，可进行影像学评价，其中位于左主干2枚，前降支18枚，回旋支4枚，右冠状动脉8枚。以CAG诊断结果为金标准，64SCTCA诊断ISR的敏感性为75.0％（6/8），特异性为87.5％（21/24），，阳性预测值为60.0％（6/10），阴性预测值为95.5％（21/22）。两者在诊断ISR统计学上是无明显差异的（P=0.396，P＞0.05）。结论 1、64SCTCA对冠心病患者冠状动脉近中段狭窄的诊断、介入治疗后支架内再狭窄的诊断有较高的应用价值，作为一种无创的检查手段，可作为冠心病患者介入治疗前的筛选工具和介入治疗后的随访工具。 2、64SCTCA可初步为临床提供动脉粥样硬化斑块的性质，有利于临床及时干预、治疗。 3、64SCTCA的多种后处理方法能更直观的显示冠状动脉解剖结构及先天性畸形，为临床诊断提供有效的方法。
[Abstract]:objective
The diagnostic results of 64 row CT coronary angiography (64SCTCA) for coronary artery stenosis were compared with the results of coronary angiography (CAG), and the results were not the same. The accuracy of the diagnosis of the stenosis of the proximal coronary artery by 64SCTCA was evaluated and the properties of the plaque were evaluated preliminarily. The evaluation of the results of CAG was the standard and evaluation. The diagnostic value of 64SCTCA in coronary artery stent restenosis (ISR).
Materials and methods
120 cases of 64SCTCA were collected from April 2011 to December 2012 in the Affiliated Hospital of Tai'an Medical College image center, of which 22 cases of coronary heart disease were diagnosed with 64SCTCA and CAG. The CT examination images were passed to the AW4.4 post processing workstation and the results of.64SCTCA examination and the results of CAG examination were two radiology and two respectively. The Department of Cardiology doctors did not know the result of each other. The results of the two methods were compared statistically.
At the same time, 18 patients were followed up with 64SCTCA and CAG for coronary intervention (PCI). The results of 64SCTCA and the results of CAG were analyzed by two radiologists and two Department of Cardiology physicians. The results of the two methods were compared.
Result
1102 patients (18 cases after PCI), 3 cases (2.9%) image quality could not be evaluated by imaging. The right dominant type in coronary artery type accounted for 66.7% (67/99), the balance type accounted for 28.3% (28/99), and the left dominant type accounted for 4.1% (4/99). There was a diagonal branch 27.3% (27/99), two diagonal branches, 61.6% (61/99), and more than two of 11.1% (11/). 99) no diagonal branches were not found; a blunt edge branch accounted for 30.3% (30/99), two blunt marginal branches accounted for 53.5% (53/99), more than two of them accounted for 16.2% (16/99), and no blunt marginal branch was found. 11 cases (11.1%) had myocardial bridge, 1 (1%) patients with coronary aneurysm and 1 (1%) patients with abnormal development of coronary artery opening.
In 2,99 patients, 409 atherosclerotic plaques were detected by 64SCTCA, including 106 calcified plaques, 218 non calcified plaques and 85 mixed plaques. The coronary atherosclerotic plaques were mostly located in the middle of the LAD, followed by the proximal and LCx segments of the RCA.
3, in the proximal and middle segment of RCA, LM, LAD near the middle segment and the near segment of LCx, the image quality of 2 patients was not evaluated. 20 patients with coronary heart disease could be used for analysis in 105 segments (87.5%). The CAG result was the gold standard, and the sensitivity of 64SCTCA to diagnose the stenosis degree more than 50% was 79.2% (19/24), the specificity was 92.6% (75/81) and positive. The diagnostic value was 76% (19/25) and the negative predictive value was 93.8% (75/80). There was no significant difference in the evaluation of lumen stenosis degree of more than 50% (P=0.870, P > 0.05).
4,18 patients were implanted with 35 stents, 32 stents (91.4%) showed good imaging, including 2 left main stem, 18 anterior descending branches, 4 circumflex branches, 8 right coronary arteries. CAG diagnosis was gold standard, 64SCTCA diagnostic ISR was 75% (6/ 8), specificity was 87.5% (21/24), and positive predictive value was 60% (6/10). The negative predictive value was 95.5% (21/22). There was no significant difference between the two in the diagnosis of ISR (P=0.396, P > 0.05).
conclusion
The diagnosis of coronary artery stenosis in patients with coronary artery disease (1,64SCTCA) is of high value in the diagnosis of stent restenosis after interventional therapy. As a noninvasive method, it can be used as a screening tool for patients with coronary heart disease before interventional therapy and a follow-up tool after interventional therapy.
2,64SCTCA can provide preliminary clinical characteristics of atherosclerotic plaques, which is conducive to timely clinical intervention and treatment.
3,64SCTCA's post-processing methods can more directly display coronary artery anatomical structure and congenital malformations, and provide an effective method for clinical diagnosis.
【学位授予单位】：泰山医学院
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R541.4;R816.2

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