多层螺旋CT在冠心病的临床应用价值及存在问题[1]

实用临床医药杂志

・50・Journal of Clinical Medicine in Practice2010年第14卷第5期

多层螺旋CT在冠心病的临床

应用价值及存在问题

洪　莉,顾　翔

(扬州大学医学院附属苏北人民医院心血管内科,江苏扬州,225001)

摘　要:目的　在病例非选择性的基础上,将多层螺旋CT冠状动脉血管造影(CTA)与侵入性冠状动脉造影(ICA)相比,评估其准确性及敏感性,并分析其伪影产生的原因以及解决方法。方法　对45名可疑冠心病患者在7～10d先后予以CTA 及ICA检查,将二者相比。结果　对45名患者从节段水平分析其敏感性、特异性、阳性预测值、阴性预测值为:85.0%,99.

1%,93.1%,98.0%;患者水平分别为:84.8%,75.0%,90.3%,64.2%。结论　CTA诊断准确性高,尤其表现在节段水平对于阴性预测值判断,从患者水平分析,其诊断价值下降,显示对于高度危险患者,常规行CTA检查,并不能从中获益。由于患者自身或扫描的原因会出现影响图像诊断的伪影,对这些伪影的成因及特点进行分析有助于提高CTA的成功率及避免假阳性的诊断。

关键词:多层螺旋CT冠状动脉血管造影;冠心病;伪影

中图分类号:R541.4;R814.43 文献标识码:A 文章编号:1672Ο2353(2010)05Ο0050Ο04

Clinical applications and pitfalls of Multislice

Computed tomography in coronary artery disease

H ONG Li,GU Xiang

(Depart ment of V asculocardiology,S ubei People′s Hospital,Medical College of Yangz hou

U niversity,Yangz hou,Jiangsu,225001)

ABSTRACT:Objective　Multislice Computed tomography coronary angiography(CTA)is in2 creasingly used as an alternative to diagnostic coronary angiography for visualizing coronary arteries.

The major limitation of recently published studies,aside from being monocentric in nature and the patients included,is the selection of patients.These studies did not provide any answers for patients who are seen daily in cardiology consultation.The purpose of this study wis to determine the diag2 nostic accuracy of CTA as compared with coronary angiography on a population of average patients who were not selected.To investigate the causes and strategies of artifact and pitfalls of coronary artery imaging.Methods　Forty-five patients with suspected coronary artery disease underwent CTA followed by invasive coronary angiography7with in to10days.The diagnostic accuracy de2 tection of significant coronary stenoses(greater than50%stenoses in arteries greater than1.5mm in diameter)was determined and the two techniques were compared.R esults　The sensitivity,speci2 ficity,positive and negative predictive value of CTA in detecting significant coronary stenoses were 85.0%,99.1%,93.1%and98.0%in per-segment evaluation.During the per-patient evalua2 tion,the efficacy of CTA dropped with the values being84.8%,75.0%,90.3%and64.2%re2 spectively.Conclusion　The use of CTA results in excellent diagnostic accuracy and in anincreased negative predictive value for detecting significant coronary stenoses in per-segment analysis.Per-patient analysis significantly reduced the value of scanning,demonstrating that patients with a high probability of coronary artery disease do not benefit from this type of non-invasive approach.By reasons of patients themselves orscan protocols,the artifacts will appear.To analyze the causes

收稿日期:2009-12-11

通讯作者:顾翔,E-mail:sbyygx@