64层螺旋CT在评价冠状动脉支架术后支架内再狭窄中的价值  

Value of 64-slice spiral computed tomograph in evaluation of in-stent restenosis after coronary stenting

作　　者：张海军[1] 靳文军[1] 花霞[2] 李曦[2] 朱国英[1] 王献忠[1] 冯乐[3] 赵君 苏瑞瑛[5] 肖文良[5] 

机构地区：[1]邯郸市第一医院心血管内科,河北邯郸056002 [2]邯郸市第一医院功能科,河北邯郸056002 [3]邯郸市第一医院导管室,河北邯郸056002 [4]邯郸市第五医院内科,河北邯郸056003 [5]河北医科大学第三医院心血管内科,河北石家庄050051

出　　处：《临床荟萃》2009年第13期1136-1140,共5页Clinical Focus

摘　　要：目的探讨64层螺旋CT(64SCT)在评价冠状动脉支架术后支架内再狭窄的能力和可靠性。方法50例冠状动脉支架术后患者(共92枚支架),同期行64SCT冠状动脉扫描和选择性冠状动脉造影(CAG)。用64SCT的平扫图像行钙化积分测定,以CAG结果为金标准,分析与64SCT诊断支架开通或再狭窄的特异度、敏感度和一致性。结果64SCT对92枚支架显影良好72枚支架中直径≥3.0mm者57枚(79.2%),64SCT显示支架内狭窄程度>50%有21枚,CAG证实17枚,CAG和64SCT对其余51枚支架均显示无再狭窄或支架内狭窄程度为0～50%。在64SCT不能进行影像学评价的20枚支架中,支架直径<3.0mm者8枚(40.0%)。64SCT诊断冠状动脉支架腔内狭窄>50%的敏感度和特异度分别为94.1%和90.9%,一致率为91.7%,阳性预测值76.2%,阴性预测值98.0%,因其无创性特点而具有临床应用价值。结论64SCT可清晰显示冠状动脉支架的位置、形态、支架远近端血管及支架腔内情况,能较准确地评价冠状动脉支架术后支架内再狭窄的发生,尤其对大直径支架的评估价值较高。Objective To evaluate the diagnostic accuracy and reliability of 64-slice spiral computed tomography （64SCT） in the evaluation of in-stent restenosis（ISR） after coronary stenting. Methods Fifty patients 92 stents who had been performed coronary stenting were included in the study. All the patients were examined by 64SCT coronary angiography and conventional coronary angiography（CAG） for evaluating ISR after coronary stenting. Calcium scoring was estimated on plain scan. The diagnostic accuracy of 64SCT to detect in-stent restenosis was evaluated referring to quantitative coronary angiography. Results Of all 92 stents, 72 （78.3 %） could be assessed by 64SCT, Of all the 72 assessable stents,there were 57（79.2%） whose diameters were no shorter than 3.0 mm. Of the 20 stents with ISR〉 50% indicated by 64SCT, 17 could be detected by CAG. The other 51 stents were not found to have ISR, or ISR 0-50 %. Of the 20 uninterpretable stents, there were 8 stents （40.0%） whose diameters were shorter than 3.0 mm. The sensitivity, specificity and positive and negative predictive value to identify 〉 50 % coronary ISR was 94.1%, 90.9%, 76.2% and 98.0%, respectively. Conclusion 64SCT can accurately evaluate ISR, especially for longer diameter of stents after coronary stenting. 64SCT has clinical application value due to its non-invasive nature.

关 键 词：冠状动脉疾病 冠状血管造影术 体层摄影术 螺旋计算机 支架 

分 类 号：R541.4[医药卫生—心血管疾病]