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目的对双源CT(DSCT)冠状动脉成像与选择性X线冠状动脉造影(SCA)进行对比研究,评价DSCT对冠状动脉狭窄诊断的准确性。方法47例疑似冠心病患者(男35例,女12例,年龄63.3±10.4岁,心率76.2±14.8/min)在不控制心率的情况下行DSCT冠脉成像检查,在其后2周内行SCA检查以作为诊断冠状动脉狭窄的参考标准。将DSCT原始数据行多平面重建(MPR)、曲面重建(CPR)、最大密度投影(MIP)及容积再现技术(VRT)图像重建,结果分别由两名医师进行双盲评估。结果DSCT图像可评价节段达到94.98%(625/658),图像优良率95.52%(597/625)。DSCT诊断冠状动脉狭窄的敏感性、特异性、阳性预测值及阴性预测值分别为91.8%、98.3%、94.4%、97.5%,其中对左主干、左前降支及右冠状动脉的敏感性及特异性达到95%,对角支、左回旋支分支及右冠状动脉远端的诊断敏感性有所下降,分别为86.0%、71.4%、76.9%。结论在不控制心率的情况下,DSCT诊断冠脉狭窄安全可靠,可广泛用于冠心病患者的筛查、冠状动脉手术/支架术前评估及术后随访。
Objective To compare the DSCT coronary angiography with selective angiography (SCA) and evaluate the accuracy of DSCT in the diagnosis of coronary artery stenosis. Methods Forty-seven patients with suspected coronary artery disease (35 males and 12 females, aged 63.3 ± 10.4 years and heart rate 76.2 ± 14.8 / min) underwent DSCT coronary angiography without heart rate control and SCA As a reference for the diagnosis of coronary artery stenosis. The DSCT raw data were reconstructed by MPR, VRP and MIR reconstruction. The results were evaluated by two doctors respectively. Results The DSCT image evaluable segment reached 94.98% (625/658), the excellent and good image rate was 95.52% (597/625). The sensitivity, specificity, positive predictive value and negative predictive value of DSCT in the diagnosis of coronary artery stenosis were 91.8%, 98.3%, 94.4% and 97.5% respectively. The sensitivity and specificity of DSCT to the left main coronary artery, left anterior descending artery and right coronary artery The sensitivity of the diagonal branch, the left circumflex branch and the distal right coronary artery decreased to 95%. The sensitivity was 86.0%, 71.4% and 76.9% respectively. Conclusion Without control of heart rate, DSCT is safe and reliable for the diagnosis of coronary artery stenosis. It can be widely used in coronary heart disease screening, preoperative coronary artery surgery / stent and postoperative follow-up.