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目的以冠状动脉节段为基础,对照冠状动脉血管内超声(IVUS)结果,评价64排螺旋CT(64-MSCT)检查冠状动脉粥样斑块的能力及准确性。方法选择2009年11月至2010年1月50例怀疑或确诊的冠心病患者,其中男性38例,女性12例;年龄42～74岁,平均年龄55岁。行64-MSCT成像,2周内行冠状动脉IVUS,对186个冠状动脉斑块的64-MSCT及IVUS图像行对照研究。IVUS根据斑块回声特点将斑块分为钙化斑块、纤维斑块、软斑块(包括纤维脂质和坏死核心),64-MSCT则测量斑块密度,以CT值表示。结果对照IVUS结果,MSCT对出现任何粥样硬化斑块节段的诊断灵敏度为93.2%,特异度为91.6%。非钙化斑块组斑块含有较多的纤维和纤维脂质成分,与钙化斑块组相比差异具有统计学意义。与非钙化斑块组相比,混合斑块组和钙化斑块组含有较多的坏死核心成分。结论 64-MSCT具有良好的检查冠状动脉粥样斑块的能力,64-MSCT与IVUS结果具有相关性。
Objective To evaluate the ability and accuracy of 64-slice spiral CT (64-MSCT) to detect coronary atherosclerotic plaque based on the results of coronary intravascular ultrasound (IVUS) based on coronary artery segments. Methods Fifty suspected or confirmed patients with coronary heart disease were selected from November 2009 to January 2010, including 38 males and 12 females. The patients were 42-74 years old with a mean age of 55 years. Line 64-MSCT imaging, coronary artery IVUS within 2 weeks, 186 coronary artery plaques 64-MSCT and IVUS image control study. IVUS divided the plaque into calcified plaque, fibrous plaque and soft plaque (including fibroids and necrotic core) according to the features of plaque echo. The plaque density was measured by 64-MSCT and expressed as CT value. Results According to the IVUS results, the diagnostic sensitivity of MSCT for any of the atherosclerotic plaque segments was 93.2% and the specificity was 91.6%. Non-calcified plaque group plaque contains more fiber and fiber lipid components, compared with the calcified plaque group, the difference was statistically significant. Compared with non-calcified plaque group, mixed plaque group and calcified plaque group contained more necrotic core components. Conclusion 64-MSCT has a good ability to detect coronary atherosclerotic plaques. The correlation between 64-MSCT and IVUS results is significant.