目的建立并评价电子束CT(EBT)两种方法在冠状动脉搭桥术后(CABG)随访应用中的价值。方法本组共214例CABG患者进行了EBT两种方法的扫描：(1)电子束CT血管造影(EBA)，以完成冠状动脉及搭桥血管的三维重建；(2)电子束CT血流扫描，以得到冠状动脉及其搭桥血管的血流曲线。结果本组共分析了589条冠状动脉搭桥血管(10条血管因图像伪影而除外)。133条动脉材料的血管桥通畅率超过静脉桥(P＜0.001)。三维重建方法诊断的敏感性、特异性和准确性分别是97.7％、94.1％和96.7％，均高于血流扫描方法(分别是88.4％、82.4％和85.2％)。动脉与静脉血管桥内的平均血流量分别为4.9±2.2 ml·min-1·g-1和6.9±2.8 ml·min-1·g-1(P＜0.001)。结论电子束CT血管造影配合三维重建方法有利于观察冠状动脉及其搭桥血管的解剖，而血流扫描方法有利于观察并定量评估搭桥血管内的血流，两种方法的结合是理想的冠状动脉搭桥术后随访的无创影像方法。%Objective To establish and evaluate two protocols for the noninvasive visualization and assessment of coronary artery bypass graft (CABG) patency on electron beam tomography (EBT).Methods Two hundred and fourteen consecutive patients who underwent coronary artery bypass graft surgery were scanned using both EBT angiography with 3-dimensional reconstruction and EBT flow study with time-density-curve analysis.Results There were 589 CABGs evaluated in this study (10 grafts were excluded because of artifacts). Among them, 133 (98.5％) of 135 arterial grafts were patent, and 345 (77.7％) of 444 saphenous-vein grafts were patent. Within 5 years or between 5 and 10 years after operation, arterial graft patency exceeded venous graft patency (P ＜ 0.001 ). Three-dimensional EBT angiography achieved higher sensitivity, specificity and accuracy (97.7％, 94.1％ and 96.7％, respectively) than did EBT flow study (88.4％, 82.4％ and 85.2％, respectively) for evaluating occlusion or patency of CABG. The intra-graft flow of patent arterial and venous grafts were 4.9 ± 2.2 mi · min-1 · g-1 and 6.9 ± 2.8 mi · min-1 · g-1,respectively (P＜0.001).Conclusion The combination of EBT three-dimensional reconstruction and flow study can be more effective in the assessment of CABG anatomy and quantification of patent CABG blood flow.
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