320排CT冠状动脉支架术后再狭窄的应用价值初探  

Study on the Application Value of 320-row CTA for the Coronary Stent

作　　者：曹绍东[1] 张旭昌 王丹[1] 张同[1] 董丹丹[1] 申宝忠[1] 

机构地区：[1]哈尔滨医科大学附属第四医院,黑龙江哈尔滨150001 [2]蓬莱市人民医院内一科,山东蓬莱265600

出　　处：《现代生物医学进展》2012年第31期6080-6082,共3页Progress in Modern Biomedicine

基　　金：科技部国际科学合作项目(2009DFB30040);哈尔滨市科技攻关计划项目(2007AA3CS085)

摘　　要：目的:探讨320排CT冠状动脉成像对冠状动脉支架术后再狭窄的应用价值。方法:回顾性分析110例冠状动脉支架术后患者的320排CT资料及冠状动脉造影资料,以常规冠状动脉造影结果作为"金标准"进行对比分析。统计学方法采用Kappa评价方法。结果:200枚支架均显示优良,320排CT能够对支架置入术后的通畅情况、术后血栓形成等情况进行观察及评估。冠状动脉造影示冠状动脉支架内中度以上再狭窄62枚,320排CTA二维、三维图像及仿真内镜正确诊断50枚,漏诊2枚,误诊10枚,320排CTA诊断支架内再狭窄的敏感性96.87%、特异性95.83%、准确度78.50%、阳性预测值91.18%、阴性预测值98.57%,Kappa值的u检验中得到:u=16.2494,存在一致性,Kappa值=0.6920,参照评价原则,320排CTA和冠状动脉造影对支架内狭窄程度评估一致性极好。结论:320排CTA二维、三维图像能很好显示冠状动脉支架术后管腔,对再狭窄部位、性质、程度能够进行准确全面的观察,而且无创、重复性好,对支架术后疗效观察和随访有较高的临床应用价值。Objective： To explore the application value of 320-row coronary computed tomography after coronary stenting. Methods：Performance of 320-row CT and Coronary angiography data of 110 patients with coronary stenting were analyzed retrospectively. For the evaluation, CAG served as the standard of reference. Statistical analyses were performed with Kappa approach. Results：All of the 200 stents of 320-row CTA images were well displayed. The coronary lumen condition after operation can be well evaluated with 320-row CTA. 62 stents of all the cases with significant in-stent restenosis were confirmed by CAG. Except for 2 stents of misdiagnosis, 50 stents were identified by 320-row CTA. Meanwhile, 10 stents were missed. The sensitivity, specificity, accuracy, positive predictive value and negative predictive value of 320-row CTA were 96.87%,95.83%,78.50%,91.18%,98.57%, respectively. According to the standard of U =16.2494, Kappa value was 0.6920. It indicated a quite good consistency between 320-row CTVE and CAG on the evaluation of the degree of the in-stent stenosis. Conclusions： 320-row CTA combined with 2D and 3D reconstruction can display visually postoperative images of coronary artery stent of inside surfaces. And it can give accurate scene of the site of stent restenosis, including the profiles of quality and extent. In addition, this protocol has some other advantages： noninvasive, reproducible. Therefore, 320-row CTA is valuable for the clinical observation and evaluation on the coronary stent.

关 键 词：冠状动脉支架术 X线计算机断层扫描 320排CT 再狭窄 诊断价值 

分 类 号：R541[医药卫生—心血管疾病] R814.42[医药卫生—内科学]