64排螺旋CT对慢性完全闭塞冠状动脉病变介入术前血管评估及术中指导价值  

Values in preoperative assessment of occlusion and intra-operative guidance of 64 row spiral CT in percutaneous coronary intervention for chronic coronary occlusion

作　　者：曲新凯[1] 方唯一[1] 叶剑定[2] 陈群惠 关韶峰[1] 焦静[2] 

机构地区：[1]上海交通大学附属胸科医院心内科,200030 [2]上海交通大学附属胸科医院放射科,200030

出　　处：《中华医学杂志》2008年第46期3268-3271,共4页National Medical Journal of China

基　　金：上海市卫生局科技发展基金资助项目（054027）

摘　　要：目的分析64排螺旋CT对慢性完全闭塞病变的介入术前评估和预测价值，以及其对介入治疗的术中指导性作用。方法入选明确慢性完全闭塞病变患者，行64排螺旋CT血管造影和冠状动脉造影检查，对比分析两种手段测得闭塞段长度、钙化识别率。接受介入治疗的患者，分析病变特征对介入成功与否的预测作用。对所有闭塞病变血管进行三维重建，利用得到的图像指导介入治疗过程。结果共入选15例患者，确诊17个慢性完全闭塞病变。螺旋CT血管重建可以显示所有17个闭塞病变的长度；螺旋CT的钙化识别率为76．5％，明显高于冠脉造影的钙化识别率（41．2％）；螺旋CT可以对钙化处皿管进行横断面截切，确定钙化程度〈50％有3个，≥50％有10个。其中，11例患者的12个完全闭塞病变接受介入治疗，6例成功，6例失败。单因素分析显示，病变长度、闭塞近端有无分支、桥侧枝形成、闭塞断端形态以及造影提示的钙化情况与介入成功与否没有明显的相关性；失败组钙化面积≥50％的比例明显高于成功组（83．3％VS16．7％，P=0．05）。所有的完全闭塞病变均可以通过CT冠脉重建技术得到三维血管图像。结论64排螺旋CT具有较高的钙化病变识别能力，可以进行冠脉血管三维图像重建，有效指导介入治疗。Objective To instigate the values of 64 row spiral CT in pre-operative assessment of the occlusion and intra-operative guidance in percutancous coronary intervention for chronic total occlusion （CTO） in coronary heart disease. Methods Fifteen coronary disease patients planned to receive percutaneous coronary intervention underwent 64-row spiral CT-coronary angiography and coronary angiography （CAG）. The diagnostic effects of these 2 techniques were compared. Results Seventeen CTO lesions were confirmed. MSCT succeeded to show the lengths of the 17 CTO lesions with a calcification identification rate of 76. 4%, significantly higher than that of the CAG （ 41. 5% ）. By cross-section examination, MSCT succeeded to detect the occlusion degree of the calcified lesions, and showed that 3 CTO lesions were occluded at a rate 〈 50%, and 10 lesions at a rate ≥50%. Twelve complete occlusion lesions in 11 patients underwent PCT, success was seen in 6 of which and failure in the other 6. Univariate analysis showed that the length of lesion, branching at the proximal site, formation of bridging lateral branch, form of occlusion end, and calcification were all not significantly related to the success or failure of intervention. The percentage of the calcification area ≥50% in the intervention failure group was 83.3%, significantly higher than that in the intervention success group （ 16.7%, P = 0.05 ）. 3-D images of coronary artery could be obtained by MSCT to show all the complete occlusive lesions. Conclusion 64-MSCT demonstrates a remarkable ability to identify silieified lesions, can re-establish 3-D images of coronary artery, and effectively guide the intervention therapy.

关 键 词：冠状动脉疾病 心血管造影术 体层摄影术 X线计算机 

分 类 号：R686[医药卫生—骨科学]