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目的:分析897例临床确诊或疑似冠心病患者的40层螺旋CT冠状动脉成像结果,以探讨40层螺旋CT冠状动脉成像在冠心病诊断和随访中的价值。方法:262例临床确诊和579例疑似冠心病患者予以40层螺旋CT冠状动脉成像检查,经最大密度投影、容积重建和曲面多平面重建等后处理,其中207例患者曾行选择性冠状动脉造影检查,将40层螺旋CT冠脉成像检查结果对照冠状动脉造影检查结果计算其敏感性、特异性、准确性、阳性预测值和阴性预测值。有135例患者1年后再次做40层螺旋CT冠状动脉成像检查。结果:94%患者冠状动脉成像图像可用于分析。有斑块伴中重度狭窄病例512例,包括单支病变216例,2支病变169例,3支病变127例。男女性可疑冠心病患者40层螺旋CT冠状动脉成像结果显示:无斑块或有斑块伴轻度狭窄的比例女性患者为56.98%(200/351),男性患者为45.18%(103/228),χ2=7.72,P<0.01,随着年龄的增长,冠状动脉多支病变逐渐增多。207例多层螺旋CT冠状动脉成像与冠状动脉造影结果对比显示,冠状动脉分支血管有意义狭窄(≥50%)的敏感性为84.5%(223/264);特异性为97.3%(1117/1148);阳性预测值为87.8%(223/254);阴性预测值为96.5%(1117/1158);准确性为94.9%(1340/1412)。135例患者1年后重复40层螺旋CT冠状动脉成像显示有斑块消失6处、有斑块缩小5处、有新斑块出现9处、有斑块扩大10处。结论:40层螺旋CT作为无创性冠状动脉病变诊断技术可作为冠心病筛查,随访的良好方法,尤其适合临床症状较多的女性患者的鉴别诊断以及合并有高血压、糖尿病、血脂异常的高龄患者的随访。
Objective: To analyze the results of 40-slice spiral CT coronary angiography in 897 patients with clinically confirmed or suspected coronary heart disease so as to investigate the value of 40-slice spiral CT coronary angiography in the diagnosis and follow-up of coronary heart disease. Methods: A total of 262 clinically diagnosed patients and 579 suspected patients with coronary heart disease were examined by 40-slice spiral CT coronary angiography. After maximum density projection, volume reconstruction and surface multiplanar reconstruction, 207 patients underwent selective coronary angiography The sensitivity, specificity, accuracy, positive predictive value and negative predictive value of 40-slice spiral CT coronary angiography were compared with those of coronary angiography. One hundred and thirty-five patients underwent a 40-slice spiral CT coronary angiography one year later. RESULTS: Coronary imaging in 94% of patients was available for analysis. There are 512 cases of plaque with moderate to severe stenosis, including 216 cases of single-vessel disease, 169 cases of 2 lesions and 127 lesions of 3 lesions. Results of 40-slice spiral CT coronary angiography in men and women with suspected coronary heart disease showed that 56.98% (200/351) of the female patients without plaque or plaque with mild stenosis were 45.18% (103/228) male patients, , χ2 = 7.72, P <0.01, with age, multi-vessel coronary artery lesions gradually increased. The correlation between coronary angiography and coronary angiography in 207 cases of multislice CT showed that the sensitivity of coronary artery branches with significant stenosis (≥50%) was 84.5% (223/264) and the specificity was 97.3% (1117/1148 ); The positive predictive value was 87.8% (223/254); the negative predictive value was 96.5% (1117/1158); the accuracy was 94.9% (1340/1412). One hundred and fifty-five patients underwent repeated 40-slice spiral CT coronary angiography at one year. There were 6 plaques disappeared, 5 plaques were reduced, 9 new plaques appeared and 10 plaques were enlarged. Conclusion: 40-slice spiral CT as a noninvasive coronary artery disease diagnostic technique can be used as coronary heart disease screening, follow-up of a good method, especially for women with more clinical symptoms in the differential diagnosis and complicated with hypertension, diabetes, dyslipidemia Patient’s follow-up.