Recommended Method of Multislice Voronary CT Angiography in the Diagnosis of Coronary Lesion <?xml:namespace prefix = o ns = "urn:schemas-microsoft-com:office:office" />

张竹花　金征宇　林松柏　李冬晶　孔令燕　王怡宁　薛华丹　王沄　王林辉　赵文敏　牟文斌　张立仁　朱文玲　张抒扬　倪超　任华　于洪泉　苗齐　方圻

中国医学科学院协和医院大学北京协和医院放射科　北京 100730 

Abstract

Object: To establish a universal diagnostic method of multislice coronary CTA to observe the coronary lesion so as to facilitate multi-center cooperation.

Methods: Plain and enhanced 16-slice spiral CT imaging was performed in 300 cases. Two dimensional and three dimensional reconstruction with enhanced scan diastolic period images were made in all cases, among them 40 cases with the first grade image quality underwent conventional coronary angiography. Diagnostic method of multislice coronary CTA to observe the coronary lesion was summarized .Then sensitivity，specificity and accuracy of coronary CT angiography(CTA) in the diagnosis of ³50% coronary stenosis were calculated.

Result：Diagnostic method of multislice coronary CTA to observe the coronary lesion includes two dimensional diagnostic method(including two angle segmental demonstration method, curved reconstruction method, slice by slice observation method and perpendicular section method) and the auxiliary demonstration method of three dimensional and virtual endoscopy demonstration method. The sensitivity, specificity and accuracy of 16-slice spiral coronary CTA to identify ³50% stenosis were 100% and 97.3% respectively.

Conclusion：16-slice spiral coronary CTA is a noninvasive，simple and good method, if with high image quality, it can be used as a reliable method in the diagnosis of coronary heart disease, especially as a reliable method for the early diagnosis of coronary heart disease.

Key words：Tomography , X-ray computed; Coronary vessels; Coronary heart disease

随着CT技术的发展，目前多层螺旋CT 冠状动脉CTA已被广泛接受为一种冠心病的筛查手段，但对冠状动脉病变的影像学观察诊断方法尚无人详述，本文总结了多层螺旋CT冠脉病变观察推荐方法。

材料与方法

一、临床资料

2002年8月至2003年10月，为300例临床怀疑冠心病的患者进行了心脏冠状动脉CT成像。其中35例临床怀疑有冠心病的患者有冠状动脉造影对照。对心率>70次/min的患者检查前口服倍他乐克50mg，30min后进行检查。服用倍他乐克的禁忌证有Ⅱ～Ⅲ度房室传导阻滞、失代偿性心功能不全、心源性休克和显著心动过缓病史、哮喘等。为避免二甲双胍与对比剂协同作用加大肾功能损害的可能性，服用二甲双胍等双胍类降糖药的糖尿病患者在停药48h后（停药期间可咨询内分泌科医师换用其他降糖药）再检查，检查后饮水或输液保证体内有足够的水分，待肾功能稳定后再恢复使用双胍类降糖药。患者应没有严重的心律不齐。