双源CT冠状动脉成像在心律失常患者中的初步应用  

Application of Dual-source CT Coronary Angiography in the Patients with Arrhythmia

作　　者：刘成磊[1,2] 杨立民[2] 徐凯[1] 

机构地区：[1]徐州医学院附属医院影像科,江苏徐州221002 [2]蚌埠医学院附属连云港医院影像科

出　　处：《实用放射学杂志》2010年第10期1447-1451,共5页Journal of Practical Radiology

摘　　要：目的 探讨双源CT冠状动脉成像在心律失常患者中诊断冠状动脉明显狭窄的可行性及准确性.方法 连续选取60例临床高度怀疑或已确诊冠心病的患者,且行双源CT扫描过程中,出现心率变异过大（心率〉14次/min）或心律失常,其中30例入院患者在2~3周内行选择性冠状动脉造影检查.以选择性冠状动脉造影为标准,从冠状动脉节段及冠状动脉分支2个角度分别评价双源CT在诊断冠状动脉明显狭窄中的敏感性、特异性、准确性、阳性预测值及阴性预测值.结果 60例出现心电信号异常患者中,心率55~269次/min,平均心率（92.8±31.9）次/min.编辑前图像质量总评分为2.26±1.03,编辑后图像质量总评分为3.50±0.61.其中30例行选择性冠状动脉造影的患者中,以冠状动脉节段为基础双源CT诊断冠状动脉明显狭窄的敏感性、特异性、阳性预测率、阴性预测率、准确性为64.0%、97.14%、76.19%、94.97%、93.0%.以冠状动脉分支为基础双源CT诊断冠状动脉明显狭窄的敏感性、特异性、阳性预测率、阴性预测率、准确性为73.81%、89.61%、79.48%、86.25%、84.03%.经χ2 检验,χ2 值分别为1.75、0.21,P值均＞0.05,双源CT与选择性冠状动脉造影比较,不管从冠状动脉节段角度还是从冠状动脉分支角度分析,两者在诊断冠状动脉明显狭窄时没有统计学意义.结论 双源CT冠状动脉成像在心律失常患者的应用是可行的,经心电编辑后图像质量明显改善,对于冠状动脉明显狭窄的诊断有较高的准确性.Objective To evaluate the accuracy and feasibility of dual-source CT in detecting coronary artery stenoses in the patients with arrhythmia. Methods 60 patients without stable sinus rhythm and scheduled for DSCT because of suspected or known coronary artery disease were included in this study. 30 cases of them underwent coronary angiography{CAG） 2-3 weeks after admission. The CAG results were served as ＂gold standard＂ to evaluate the diagnostic accuracy of DSCT in significant stenosis of coronary artery in per--segment and in per--artery analysis. Results In 60 patients without stable sinus rhythm,the heart rate was 55- 269 bpm/min, with mean heart rate was （92.8 ±31.9）bpm/min. The overall mean image quality scores before and after ECG editing were 2.26 d： 1.03 and 3.50±0.61, respectively. In 30 patients undergone CAG, based on per--segment analysis, the sensitivity, specificity,positive value,negative predictive value and agreement rate of DSCT were 64.0%,97.14% ,76.19% ,94.97% and 93.0% （X^2= 1.75, P〉 0.05 ） respectively, while based on per-- artery analysis, the sensitivity, specificity, positive value, negative predictive value and agreement rate of DSCT were 73.81%, 89.61%, 79.48 %, 86.25 % and 84.03 % （ X^2= 0. 21, P〉0.05 ） respectively. There was no statistical difference in the diagnosis of coronary arterial stenosis between DSCT and CAG. Conclusion Dual-source CT has a high accuracy in diagnosis of coronary arterial stenoses and can be regarded as one of no--trauma metheds to diagnosis coronary arterial stenoses for patients with arrhythmia.

关 键 词：心脏 冠状动脉造影 心律失常 冠心病 体层摄影术 X线计算机 

分 类 号：R541.7[医药卫生—心血管疾病] R814.43[医药卫生—内科学]