256层螺旋CT在冠状动脉狭窄评估中的应用价值

摘要

Objective To investigate the application value of 256 slice CT angiography(CTA)for diagnosing coronary artery steno-sis.Methods Two hundred patients suspected of coronary heart disease underwent 256 slice CTA examination,32 of whom under-went coronary angiography.According to the American Heart Association (AHA)for coronary artery segment method,coronary artery could be divided into 15 segments,to evaluate the image quality of each segment on a five point scale.The CAG results were regar-ded as gold standard,the diagnosis capacity of CTA for detecting coronary artery stenosis were analyzed.Resutls 2 385 segments were considered four and five score of 2 502 segments shown with CTA examination.Compared with the CAG results,the accuracy rate of 256 slice CTA in diagnosing coronary artery stenosis was 91.24%,the sensitivity was 90.52%,and the specificity was 91.54%, there was high consistency in the results of CTA and CAG in diagnosing coronary artery stenosis.The sensitivity rates of CTA for e-valuating the different coronary artery stenosis were:mild stenosis (66.67%),moderate stenosis (83.87%),severe stenosis (89. 19%).Conclusion The 256 slice CTA can display each segment of coronary artery clearly,and analysis and evaluate the segmen-tal stenosis better.So,as a noninvasive examination,the 256 slice CTA has important clinical value in the screening of coronary heart disease(CHD),and it can provide more reliable information for the selection of treatment.%目的：探讨256层螺旋 CT在冠状动脉成像及管腔狭窄诊断中的应用价值。方法选取200例临床疑诊或拟诊为冠心病的患者,均行256层螺旋 CT扫描,其中32例行冠状动脉血管造影(CAG)。按照美国心脏协会(AHA)制订的冠状动脉分段方法,将冠状动脉细分为15个节段,分别对各节段 CTA图像质量进行评价,并以 CAG为金标准,评价 CTA对冠状动脉不同狭窄程度的诊断能力。结果 CTA显示冠状动脉节段共2502段,其中,评分为4分~5分者共2385段(可评价率为95.32%)。以 CAG为金标准,256层螺旋 CTA诊断冠状动脉狭窄的灵敏度为90.52%,特异度为91.54%,准确率为91.24%,两种方法评价冠状动脉狭窄的一致性较高,Kappa值为0.797；而分级诊断冠状动脉轻、中、重度狭窄的灵敏度分别为66.67%、83.87%、89.19%。结论256层螺旋 CTA可以较清晰的显示冠状动脉各节段图像,且较好的评估病变管腔狭窄程度。由此可见,256层螺旋 CTA作为一种无创检查方法,在冠心病的筛查中具有重要的临床应用价值,为冠心病患者进一步治疗方案的选择提供更加可靠的信息。