發(fā)布時間：2018-07-24 08:57

【摘要】：目的 觀察冠心病患者64排CT冠狀動脈成像（64SCTCA）對冠狀動脈近、中段狹窄的診斷結(jié)果，與冠狀動脈造影（CAG）結(jié)果比較，分析兩者結(jié)果不相同原因，評估64SCTCA對冠狀動脈近中段狹窄診斷的準(zhǔn)確性，并初步評估斑塊性質(zhì)。以CAG診斷結(jié)果為標(biāo)準(zhǔn)，評估64SCTCA對冠狀動脈支架內(nèi)再狹窄（ISR）診斷價值。 材料與方法 收集2011年4月至2012年12月在泰山醫(yī)學(xué)院附屬醫(yī)院影像中心行64SCTCA的患者120例，其中臨床診斷為冠心病的患者22例同時行64SCTCA和CAG檢查，CT檢查圖像傳至AW4.4后處理工作站進(jìn)行處理。64SCTCA檢查結(jié)果和CAG檢查結(jié)果分別由兩名放射科和兩名心內(nèi)科醫(yī)師在不知道對方結(jié)果的前提下進(jìn)行分析。兩種方法的結(jié)果進(jìn)行統(tǒng)計學(xué)比較。 同時行64SCTCA和CAG檢查的冠狀動脈介入治療（PCI）術(shù)后隨訪患者18例，64SCTCA檢查結(jié)果和CAG檢查結(jié)果分別由兩名放射科和兩名心內(nèi)科醫(yī)師在不知道對方結(jié)果的前提下進(jìn)行分析。兩種方法的結(jié)果進(jìn)行統(tǒng)計學(xué)比較。 結(jié)果 1、102例患者（除去PCI術(shù)后患者18例）,3例（2.9％）圖像質(zhì)量不能進(jìn)行影像學(xué)評價。冠狀動脈類型中右優(yōu)勢型占66.7％（67/99），均衡型占28.3％（28/99），左優(yōu)勢型占4.1％（4/99）。有一支對角支占27.3％（27/99），兩支對角支占61.6％（61/99），超過兩支的占11.1％（11/99），未發(fā)現(xiàn)無對角支；有一支鈍緣支占30.3％（30/99），兩支鈍緣支占53.5％（53/99），超過兩支的占16.2％（16/99），未發(fā)現(xiàn)無鈍緣支。本實驗發(fā)現(xiàn)11例（11.1％）患者存在心肌橋，1（1％）例患者冠狀動脈瘤，1（1％）例患者冠狀動脈開口發(fā)育異常。 2、99例患者行64SCTCA共檢出409處粥樣斑塊，其中鈣化斑塊106處，非鈣化斑塊218處，混合斑塊共85處，冠狀動脈粥樣斑塊多位于LAD近中段，其次為RCA近中段和LCx近段。 3、以RCA近中段、LM、LAD近中段、LCx近段為研究對象，其中2例患者圖像質(zhì)量不能進(jìn)行評價，20例冠心病患者可用于分析的節(jié)段為105段（87.5％）。以CAG結(jié)果為金標(biāo)準(zhǔn)，64SCTCA診斷管腔狹窄程度≥50％的敏感性為79.2％（19/24），特異性為92.6％（75/81），陽性預(yù)測值為76.0％（19/25），陰性預(yù)測值為93.8％（75/80）。兩者在評價管腔狹窄程度≥50％統(tǒng)計學(xué)上是無明顯差異的（P=0.870，P＞0.05）。 4、18例患者共植入支架35枚,32枚支架（91.4％）顯影良好，可進(jìn)行影像學(xué)評價，其中位于左主干2枚，前降支18枚，回旋支4枚，右冠狀動脈8枚。以CAG診斷結(jié)果為金標(biāo)準(zhǔn)，64SCTCA診斷ISR的敏感性為75.0％（6/8），特異性為87.5％（21/24），，陽性預(yù)測值為60.0％（6/10），陰性預(yù)測值為95.5％（21/22）。兩者在診斷ISR統(tǒng)計學(xué)上是無明顯差異的（P=0.396，P＞0.05）。 結(jié)論 1、64SCTCA對冠心病患者冠狀動脈近中段狹窄的診斷、介入治療后支架內(nèi)再狹窄的診斷有較高的應(yīng)用價值，作為一種無創(chuàng)的檢查手段，可作為冠心病患者介入治療前的篩選工具和介入治療后的隨訪工具。 2、64SCTCA可初步為臨床提供動脈粥樣硬化斑塊的性質(zhì)，有利于臨床及時干預(yù)、治療。 3、64SCTCA的多種后處理方法能更直觀的顯示冠狀動脈解剖結(jié)構(gòu)及先天性畸形，為臨床診斷提供有效的方法。
[Abstract]:objective
The diagnostic results of 64 row CT coronary angiography (64SCTCA) for coronary artery stenosis were compared with the results of coronary angiography (CAG), and the results were not the same. The accuracy of the diagnosis of the stenosis of the proximal coronary artery by 64SCTCA was evaluated and the properties of the plaque were evaluated preliminarily. The evaluation of the results of CAG was the standard and evaluation. The diagnostic value of 64SCTCA in coronary artery stent restenosis (ISR).
Materials and methods
120 cases of 64SCTCA were collected from April 2011 to December 2012 in the Affiliated Hospital of Tai'an Medical College image center, of which 22 cases of coronary heart disease were diagnosed with 64SCTCA and CAG. The CT examination images were passed to the AW4.4 post processing workstation and the results of.64SCTCA examination and the results of CAG examination were two radiology and two respectively. The Department of Cardiology doctors did not know the result of each other. The results of the two methods were compared statistically.
At the same time, 18 patients were followed up with 64SCTCA and CAG for coronary intervention (PCI). The results of 64SCTCA and the results of CAG were analyzed by two radiologists and two Department of Cardiology physicians. The results of the two methods were compared.
Result
1102 patients (18 cases after PCI), 3 cases (2.9%) image quality could not be evaluated by imaging. The right dominant type in coronary artery type accounted for 66.7% (67/99), the balance type accounted for 28.3% (28/99), and the left dominant type accounted for 4.1% (4/99). There was a diagonal branch 27.3% (27/99), two diagonal branches, 61.6% (61/99), and more than two of 11.1% (11/). 99) no diagonal branches were not found; a blunt edge branch accounted for 30.3% (30/99), two blunt marginal branches accounted for 53.5% (53/99), more than two of them accounted for 16.2% (16/99), and no blunt marginal branch was found. 11 cases (11.1%) had myocardial bridge, 1 (1%) patients with coronary aneurysm and 1 (1%) patients with abnormal development of coronary artery opening.
In 2,99 patients, 409 atherosclerotic plaques were detected by 64SCTCA, including 106 calcified plaques, 218 non calcified plaques and 85 mixed plaques. The coronary atherosclerotic plaques were mostly located in the middle of the LAD, followed by the proximal and LCx segments of the RCA.
3, in the proximal and middle segment of RCA, LM, LAD near the middle segment and the near segment of LCx, the image quality of 2 patients was not evaluated. 20 patients with coronary heart disease could be used for analysis in 105 segments (87.5%). The CAG result was the gold standard, and the sensitivity of 64SCTCA to diagnose the stenosis degree more than 50% was 79.2% (19/24), the specificity was 92.6% (75/81) and positive. The diagnostic value was 76% (19/25) and the negative predictive value was 93.8% (75/80). There was no significant difference in the evaluation of lumen stenosis degree of more than 50% (P=0.870, P > 0.05).
4,18 patients were implanted with 35 stents, 32 stents (91.4%) showed good imaging, including 2 left main stem, 18 anterior descending branches, 4 circumflex branches, 8 right coronary arteries. CAG diagnosis was gold standard, 64SCTCA diagnostic ISR was 75% (6/ 8), specificity was 87.5% (21/24), and positive predictive value was 60% (6/10). The negative predictive value was 95.5% (21/22). There was no significant difference between the two in the diagnosis of ISR (P=0.396, P > 0.05).
conclusion
The diagnosis of coronary artery stenosis in patients with coronary artery disease (1,64SCTCA) is of high value in the diagnosis of stent restenosis after interventional therapy. As a noninvasive method, it can be used as a screening tool for patients with coronary heart disease before interventional therapy and a follow-up tool after interventional therapy.
2,64SCTCA can provide preliminary clinical characteristics of atherosclerotic plaques, which is conducive to timely clinical intervention and treatment.
3,64SCTCA's post-processing methods can more directly display coronary artery anatomical structure and congenital malformations, and provide an effective method for clinical diagnosis.
【學(xué)位授予單位】：泰山醫(yī)學(xué)院
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2013
【分類號】：R541.4;R816.2

【參考文獻(xiàn)】

相關(guān)期刊論文 前4條

1 吳晉寶;于彥錚;;關(guān)于中國人心冠狀血管的一些觀察——Ⅰ.冠狀動脈的起點及分布類型[J];解剖學(xué)報;1966年03期

2 黃美萍;劉其順;劉輝;梁長虹;張紹斌;;多層螺旋CT冠狀動脈成像質(zhì)量及對冠狀動脈病變診斷準(zhǔn)確性的評價[J];中華放射學(xué)雜志;2006年09期

3 劉新;趙錫海;程流泉;趙紹宏;蔡祖龍;蔡幼銓;楊立;;冠狀動脈CT和MR血管成像診斷粥樣硬化斑塊和狹窄的對比研究[J];中華放射學(xué)雜志;2006年11期

4 楊立;趙林芬;李穎;王新疆;趙錫海;趙紹宏;趙紅;吳堅;劉新;蔡祖龍;;心肌橋和壁冠狀動脈的多層螺旋CT診斷及其臨床意義[J];中華醫(yī)學(xué)雜志;2006年40期

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