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目的探讨64层螺旋CT(64SCT)在评价冠状动脉支架术后支架内再狭窄的能力和可靠性。方法50例冠状动脉支架术后患者(共92枚支架),同期行64SCT冠状动脉扫描和选择性冠状动脉造影(CAG)。用64SCT的平扫图像行钙化积分测定,以CAG结果为金标准,分析与64SCT诊断支架开通或再狭窄的特异度、敏感度和一致性。结果64SCT对92枚支架显影良好72枚支架中直径≥3.0mm者57枚(79.2%),64SCT显示支架内狭窄程度>50%有21枚,CAG证实17枚,CAG和64SCT对其余51枚支架均显示无再狭窄或支架内狭窄程度为0～50%。在64SCT不能进行影像学评价的20枚支架中,支架直径<3.0mm者8枚(40.0%)。64SCT诊断冠状动脉支架腔内狭窄>50%的敏感度和特异度分别为94.1%和90.9%,一致率为91.7%,阳性预测值76.2%,阴性预测值98.0%,因其无创性特点而具有临床应用价值。结论64SCT可清晰显示冠状动脉支架的位置、形态、支架远近端血管及支架腔内情况,能较准确地评价冠状动脉支架术后支架内再狭窄的发生,尤其对大直径支架的评估价值较高。
Objective To investigate the ability and reliability of 64-slice spiral CT (64SCT) in the evaluation of stent restenosis after coronary stenting. Methods Fifty patients with coronary stents (92 stents) underwent coronary angiography with 64 SCT and selective coronary angiography (CAG) during the same period. With 64SCT plain scan line calcification score, the CAG results as the gold standard, analysis and 64SCT diagnosis of stent opening or restenosis specificity, sensitivity and consistency. RESULTS: Forty-two scaffolds were well developed by 64 SCT. Among 72 scaffolds, 57 (79.2%) had diameter ≥3.0 mm. Twenty-one scans were confirmed by 64 SCT. Fifteen scans were confirmed by CAG, 17 by CAG and 51 scaffolds by CAG and 64 SCT. All showed no restenosis or stent stenosis of 0 to 50%. Of the 20 scaffolds that were not eligible for imaging evaluation at the 64 SCT, 8 (40.0%) had a stent diameter of <3.0 mm. The sensitivity and specificity of 64SCT in diagnosing coronary stent stenosis> 50% were 94.1% and 90.9% respectively, the coincidence rate was 91.7%, the positive predictive value was 76.2% and the negative predictive value was 98.0%, which was due to its noninvasive characteristics Clinical application value. Conclusion 64SCT can clearly show the location and shape of coronary stents, the vessels in the proximal and distal stents and the intraluminal position of the stents. It can accurately evaluate the in-stent restenosis after coronary stenting, especially for the assessment of large-diameter stents .