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Noninvasive Evaluation of Coronary Artery Stenoses and Calcifications with Multi-slice Spiral Computed Tomography<?xml:namespace prefix = o ns = "urn:schemas-microsoft-com:office:office" />
王怡宁 金征宇
张竹花 孔令燕
张抒扬 林松柏
王 沄 赵文敏
ABSTRACT
Purpose: To determine the diagnostic accuracy of multi-slice spiral computed tomography（MSCT） for the assessment of coronary artery stenoses with standardized reconstruction images and to investigate the correlation of stenoses and calcifications.
Material and Methods: 47 patients (31 male, aged 60±12 years) with suspected coronary artery disease were studied by ECG-gated MSCT. Patients with a heart rate above 65/min received β-blockers before the scan. Nonenhanced scan was performed for calcium quantification. Contrast-enhanced scan (100 mL contrast agent IV at 3.5 ml/s) was performed during an approximately 20s breath hold for detection of stenosis. In axial MSCT images and standardized MIP and VRT reconstruction images, coronary arteries were assessed for the presence of stenosis exceeding 50% diameter reduction and the results were compared with conventional coronary angiography. The correlation of calcium scores and stenoses was analyzed.
Results: Conventional coronary angiography detected 54 of the 188 evaluated branches(left main, left anterior descending, left circumflex, and right coronary artery in 47 patients) significantly diseased. Without exclusion of branches, the sensitivity, specificity, accuracy, positive and negative predictive value to identify ≥50% stenosis was 93% (50/54), 92% (123/134), 92%(173/188), 82% (50/61), and 97% (123/127), respectively. The correlation coefficient of coronary calcium scores and stenoses was 0.736 (P<0.01).
Conclusion: Improvements in MSCT technology, combined with premedication with oral β-blockers allow noninvasive detection of coronary artery stenoses with high accuracy. Coronary artery stenoses have significant correlation with coronary calcifications. The establishment of CTA standard orientations is helpful for comprehensive evaluation of coronary artery in comparison to conventional coronary angiography, and will promote cooperations of multiple centers and multiple departments.
Key Words: Computed tomography ; Coronary disease ; Stenosis
冠状动脉粥样硬化性心脏病（简称冠心病）是世界范围内的常见病、多发病，发病率不断上升。常规插管冠状动脉造影是诊断冠心病的金标准，但它是一项有创检查，较难为患者接受。近几年多层螺旋CT冠状动脉造影这一无创成像方法发展迅速，本文旨在研究该方法评价冠状动脉狭窄的准确性以及探讨血管钙化和狭窄的相关关系。
材料与方法
一、临床资料
2003年12月～2004年5月间，对47例临床怀疑冠心病的患者（其中6例有冠脉支架）进行了冠脉CTA检查，并在行CT检查前或后两周内行常规冠脉造影。47例患者中，男性31例，女性16例，平均年龄60岁（35～87岁）。病例排除标准包括: 严重的心律不齐，对含碘造影剂过敏，肾功能不全。对心率>65次/min的患者（无服用美托洛尔禁忌证），检查前口服美托洛尔（商品名：倍他乐克）50 mg，1小时后进行检查。 |
