本文關(guān)鍵詞：支架置入術(shù)后64排螺旋CT冠狀動(dòng)脈圖像影響因素初步探討，由筆耕文化傳播整理發(fā)布。

        目的探討不同因素影響下64排螺旋CT冠狀動(dòng)脈成像對(duì)冠狀動(dòng)脈支架置入術(shù)后隨訪(fǎng)評(píng)估的可靠性。方法對(duì)我科2009年8月至2013年10月間129例冠狀動(dòng)脈支架置入術(shù)患者進(jìn)行64排螺旋CT冠狀動(dòng)脈成像，根據(jù)對(duì)比劑注射速率、對(duì)比劑濃度、支架直徑、支架材料、冠狀動(dòng)脈支架置入血管解剖位置不同分別進(jìn)行研究：觀察對(duì)比劑注射速率、對(duì)比劑濃度、支架直徑、支架材料、支架置入的解剖位置對(duì)64排螺旋CT冠狀動(dòng)脈支架顯影圖像質(zhì)量的影響。支架顯影質(zhì)量指標(biāo)：支架置入位置有無(wú)移位、支架內(nèi)部結(jié)構(gòu)顯影是否清晰、支架內(nèi)及支架附近血管通暢情況及遠(yuǎn)側(cè)血管顯影狀況。25例患者48枚支架冠狀動(dòng)脈CT重建圖像以冠狀動(dòng)脈造影為標(biāo)準(zhǔn)進(jìn)行對(duì)比參照，了解64排螺旋CT評(píng)估冠狀動(dòng)脈支架通暢性的準(zhǔn)確性和可靠性。結(jié)果在不同因素影響下分別觀察，患者其它因素?zé)o統(tǒng)計(jì)學(xué)差異：對(duì)比劑注射速率為4.5ml/s支架圖像顯影評(píng)估3分及3分以上占所觀察支架比例為91.4%，與4.0ml/s及3.5ml/s組比較有統(tǒng)計(jì)學(xué)差異（χ2=5.106，P=0.024和χ2=4.188，P=0.041）；濃度為370mg I/ml對(duì)比劑支架顯影在3分及3分以上所占支架比例為90.9%，濃度為350mg I/ml對(duì)比劑支架顯影在3分及3分以上所占比例為90%，均優(yōu)于對(duì)比劑濃度320mg I/ml支架圖像質(zhì)量,與濃度為320mg I/ml比較，其統(tǒng)計(jì)學(xué)上有差異（χ2=4.694， P=0.030與χ2=3.955,P=0.047）。支架直徑≥4.0mm組CT重建圖像3分及3分以上的支架占支架總數(shù)比例92.7%；支架直徑在3.0～4.0mm之間CT重建圖像3分及3分以上支架占支架總數(shù)的83.3%；與支架直徑在2.25mm～3.0mm之間CT冠狀動(dòng)脈成像比較，，其統(tǒng)計(jì)學(xué)上有顯著性差異（χ2=9.939，P=0.002與χ2=6.959,P=0.008）；左主干冠脈CT支架重建圖像3分及3分以上占支架總數(shù)比例為90.2%；前降支支架冠脈CT支架重建3分及3分以上占支架總數(shù)比例為86.4%。統(tǒng)計(jì)學(xué)處理顯示左主干和前降支內(nèi)支架CT成像質(zhì)量與回旋支和右冠脈比較，有統(tǒng)計(jì)學(xué)差異，分別為χ2=8.024，P=0.005；χ2=5.902，P=0.015與χ2=7.550,P=0.006；χ2=5.515，P=0.019。藥物涂層支架CT重建支架圖像質(zhì)量在3分及3分以上占支架總數(shù)的86.4%。統(tǒng)計(jì)學(xué)處理顯示藥物涂層支架成像質(zhì)量好于金屬裸支架（χ2=8.111，P=0.004）。以冠狀動(dòng)脈造影檢查結(jié)果為標(biāo)準(zhǔn)，64排螺旋CT支架重建對(duì)于支架閉塞診斷的敏感性為100%，準(zhǔn)確性為100%。對(duì)于閉塞加狹窄（支架狹窄程度大于50%）診斷的敏感性為90%，假陰性為10%，陽(yáng)性預(yù)測(cè)值為100%，64排螺旋CT支架重建圖像對(duì)支架狹窄（＞50%）和閉塞的診斷與冠狀動(dòng)脈造影比較，無(wú)統(tǒng)計(jì)學(xué)差異（χ2=0.057，P=0.811）。結(jié)論1.對(duì)于支架置入術(shù)后病例支架通暢性評(píng)估中，排除其它因素影響下，對(duì)比劑注射速率為4.5ml/s支架顯影圖像質(zhì)量?jī)?yōu)于對(duì)比劑注射速率為4.0ml/s、3.5ml/s；對(duì)比劑濃度370mg I/ml、350mg I/ml支架顯影圖像質(zhì)量略?xún)?yōu)于對(duì)比劑濃度320mg I/ml支架顯影圖像。2.對(duì)于支架置入術(shù)后病例支架通暢性評(píng)估中，排除其它因素影響下：支架直徑大于3.0mm冠狀動(dòng)脈重建支架圖像明顯優(yōu)于支架直徑小于3.0mm，且支架直徑越大，支架圖像越清晰；支架置入在左主干和前降支冠脈重建圖像質(zhì)量?jī)?yōu)于支架置入在回旋支和右冠脈支架；藥物涂層支架64排螺旋CT冠狀動(dòng)脈成像質(zhì)量明顯優(yōu)于金屬裸支架。3.64排螺旋CT冠狀動(dòng)脈成像與傳統(tǒng)的冠狀動(dòng)脈造影相比，具有創(chuàng)傷小、費(fèi)用低等優(yōu)勢(shì)�；究蛇_(dá)到冠狀動(dòng)脈造影相近的支架顯影清晰度和支架通暢性評(píng)估準(zhǔn)確性的要求。總之，64排螺旋CT冠狀動(dòng)脈成像在支架置入術(shù)后支架通暢性評(píng)估具有較高的準(zhǔn)確性、可靠性，是一種安全、有效、更加微創(chuàng)的影像學(xué)檢查手段，值得推廣。

    Objective: To assess the clinical value of64-slice spiral computed tomography coronaryangiography in post coronary stenting follow up with different factors.Methods:129Patients after stent implantation were examined with64-Slice ComputedTomography Angiography from August2009to October2013. The contrastmedium, thecontrast concentration, the diameter of the stent, the scaffold material and theanatomic location of stent implantation were evaluated so as to analyze their effects on the imagequality of64-slice computed tomography angiography. The image quality standards of coronaryartery stent include the anatomical position, the clarity of the internal structure, the condition ofthe flow and the distal angiography. Compared with coronary angiogram image, some imageswere reconstructed to evaluate the accuracy and reliability of using64-slice spiral computedtomography coronary angiography.Results: There was no significant difference in the other different factors. The percentageof3scores and above3(the score on coronary artery stent image evaluation with the injection speed4.5ml/s) took91.4%.It had statistic difference between the group4.5ml/s andthe groups4.0ml/s and3.5ml/s（χ2=5.106，P=0.024和χ2=4.188，P=0.04).The percentage of3scores and above3(the score on coronary artery stent image evaluation with370mg I/mldosage of contrast medium) took90.9%and the percentage of that with350mg I/ml dosageof contrast medium took90%. They were superior to the stent image quality with320mg/mldosage of contrast medium. There was significant difference between370mg I/ml/350mg I/mldosage of contrast medium and320mg/ml dosage of contrast medium（χ2=4.694，P=0.030與χ2=3.955,P=0.047）.The percentage of the image reconstructions3scores and above3with the stent diametergreater than4mm took92.7%. The percentage of that with the stent diameter between3.0mmand4mm took83.3%. It had statistic difference between the stent diameter greater than4mm(thestent diameter between3.0mm and4mm) and the stent diameter between2.25mm and3.0mm（χ2=9.939，P=0.002與χ2=6.959,P=0.008）. The percentage of3scores and above3(the scoreon coronary artery stent image evaluation with the left main coronary artery) took90.2%. Thepercentage of3scores and above3(the score on coronary artery stent image evaluation withanterior descending) took86.4%. There were significant differences between the left maincoronary artery (anterior descending) and circumflex coronary artery (right coronary artery)(χ2=8.024，P=0.005；χ2=5.902，P=0.015與χ2=7.550,P=0.006；χ2=5.515，P=0.019). Thepercentage of3scores and above3(the score on coronary artery stent image evaluation withdrug-eluting stents) took86.4%. The statistic difference showed that the image quality withdrug-eluting stents were better than that with bare metal stents（χ2=8.111，P=0.004）.Based on the results of coronary angiography, the sensibility of diagnosing stent occlusionwas100%and the accuracy100%. The sensibility of diagnosing occlusion and stenosis (Thedegree of stent stenosis greater than50%) was90%. The false negative rate was10%. Thepositive predictive value was100%. There were no significant differences between the results ofocclusion and stenosis (greater than50%) and the results of coronary angiography （χ2=0.057，P=0.811）. Conclusions:1. The image quality of coronary artery stent with injection speed4.5ml/s is better than thatbased on injection speed4.0ml/s and3.5ml/s. The image quality of coronary artery stent with400mg/ml and370mg/ml dosage of contrast medium is superior to that with350mg/ml dosageof contrast medium.2. The image quality of64-slice spiral computed tomography coronary angiographycombined with reconstruction technique with stent diameter greater than3mm is better than thatwith diameter less than3mm. The image quality of64-slice CT angiography combined withreconstruction technique on coronary artery with stenting in the left main coronary artery andanterior descending is superior to that with stenting in circumflex coronary artery and rightcoronary artery. The image quality with biodegradable stents is better than that with bare metalstent and drug-eluting stents.3. Compared with traditional coronary artery,64-slice spiral computed tomographycoronary angiography is safer, less expensive and clearer.In a word, using64-slice spiral computed tomography coronary angiography in post coronarystenting follow up is with high accuracy and reliability. It is a safe, effective andminimally-invasive imaging examination and is worth recommending.

支架置入術(shù)后64排螺旋CT冠狀動(dòng)脈圖像影響因素初步探討

英文縮略詞表5-6中文摘要6-9Abstract9-111. 前言13-142. 材料與方法14-183. 結(jié)果18-284. 討論28-365. 結(jié)論36-376．下一步研究方向37-387. 參考文獻(xiàn)38-41綜述41-52    參考文獻(xiàn)50-52

  本文關(guān)鍵詞：支架置入術(shù)后64排螺旋CT冠狀動(dòng)脈圖像影響因素初步探討，由筆耕文化傳播整理發(fā)布。