统一体位在多层螺旋CT评价冠状动脉狭窄中的应用  

Noninvasive evaluation of coronary artery stenosis by multi-slice spiral CT with standardized reconstruction images

作　　者：王怡宁[1] 金征宇[1] 孔令燕[1] 张竹花[1] 张抒扬[2] 李冬晶[3] 林松柏[3] 薛华丹[1] 王沄[1] 牟文斌[1] 

机构地区：[1]中国医学科学院 中国协和医科大学 北京协和医院放射科,100730 [2]中国医学科学院 中国协和医科大学 北京协和医院心内科,100730 [3]中国医学科学院 中国协和医科大学 北京协和医院特需医疗部,100730

出　　处：《中华放射学杂志》2007年第8期813-816,共4页Chinese Journal of Radiology

基　　金：国家科技攻关项目(2001BA705B10-17)

摘　　要：目的通过建立统一的重组图像体位研究多层螺旋 CT(MSCT)诊断冠状动脉狭窄的准确性。方法对55例临床可疑冠心病患者行16层螺旋 CT 心电门控增强扫描。用舒张期增强扫描图像行统一体位的最大密度投影(MIP)及容积显示技术(VRT)重组,分析应用 CT 血管成像(CTA)7个 MIP 重组体位和9个 VRT 重组体位评价冠状动脉狭窄≥50%的情况,将结果与常规 X 线冠状动脉造影作对照。结果共分析55例患者的220个血管分支,常规 X 线冠状动脉造影发现62个血管分支狭窄≥50%,综合7个 MIP 重组体位和9个VRT重组体位,CTA 发现58个血管分支狭窄≥50%(左主干5个,前降支21个,回旋支14个,右冠状动脉18个)。CTA 诊断冠状动脉狭窄≥50%的敏感性为94%(58/62),特异性为92%(146/158),准确率为93%(204/220),阳性预测值83%(58/70),阴性预测值97%(146/150)。结论 MSCT 诊断冠状动脉狭窄有较高的敏感性和特异性;建立统一的成像体位有利于 CTA 与常规 X 线冠状动脉造影结果对照。Objective To determine the diagnostic accuracy of multi-slice spiral computed tomography（MSCT） for the assessment of coronary artery stenosis with standardized reconstruction images. Methods Fifty-five patients （37 male, aged 59 years） with suspected coronary artery disease were studied by ECG-gated MSCT . Patients with a heart rate above 65/min received 13-blockers before the scan. Contrast-enhanced scan （80-100 ml contrast agent IV at 3.5 ml/s） was performed during an approximately 20 s breath hold for detection of stenosis. In axial MSCT images, 7 MIP and 9 VRT reconstruction images, coronary arteries were assessed concerning the presence of stenosis exceeding 50% diameter reduction and the results were compared with conventional coronary angiography （CAG）. The display of coronary arteries with different orientations of reconstruction images was evaluated. Results CAG detected 62 out of the 220 evaluated branches （left main, left anterior descending, left circumflex, and right coronary artery in 55 patients） significantly diseased. On the 7 MIP and 9 VRT reconstruction images, CTA correctly detected 58 of the 62 stenosis （ 5 at left main, 21 at left anterior descending, 14 at left circumflex, and 18 at right coronary artery）. Without exclusion of branches, the sensitivity, specificity, accuracy, positive and negative predictive value of CT angiography （CTA） to identify ≥50% stenosis was 94% （58/62） ,92% （ 146/158）, 93% （204/220） ,83% （58/70）, and 97% （146/150） respectively. Conclusions Improvements in MSCT technology allow noninvasive detection of coronary artery stenosis with high accuracy. The establishment of CTA standard orientations is helpful for evaluation of coronary artery lesions in comparison with the conventional coronary angiography, and will promote cooperations of multiple centers and multiple departments.

关 键 词：冠状动脉疾病 缩窄 病理性 体层摄影术 X线计算机 

分 类 号：R816.2[医药卫生—放射医学]