中华心血管病杂志
中華心血管病雜誌
중화심혈관병잡지
Chinese Journal of Cardiology
2012年
6期
487-491
,共5页
王健%陈晓敏%王胜煌%叶红华%崔翰斌%杜为平%周宏林%丰明俊%潘宇宁%林少沂
王健%陳曉敏%王勝煌%葉紅華%崔翰斌%杜為平%週宏林%豐明俊%潘宇寧%林少沂
왕건%진효민%왕성황%협홍화%최한빈%두위평%주굉림%봉명준%반우저%림소기
体层摄影术,X线计算机%支架%冠状血管造影术
體層攝影術,X線計算機%支架%冠狀血管造影術
체층섭영술,X선계산궤%지가%관상혈관조영술
Tomography,X-ray computed%Stents%Coronary angiography
目的 以冠状动脉造影检查结果为标准,评价320层CT冠状动脉成像诊断冠状动脉支架内再狭窄的临床价值.方法 采用前瞻性研究方法,入选冠状动脉支架置入术后的冠心病患者69例.先后行320层CT冠状动脉成像及冠状动脉造影检查,并以冠状动脉造影定量分析结果为标准,评价320层CT冠状动脉成像诊断冠状动脉支架内再狭窄的敏感性、特异性、阳性预测值及阴性预测值.对CT冠状动脉成像质量进行分级,并分析支架直径、结构厚度、数量以及心室率对CT冠状动脉成像质量和诊断性能的影响.结果69例患者共置入110枚支架,经冠状动脉造影证实其中14枚存在支架内再狭窄,而320层CT冠状动脉成像准确诊断支架内再狭窄13枚,漏诊1枚,高估狭窄程度5枚,另有6枚无再狭窄的支架因图像无法观测而判定为支架内再狭窄.320层CT冠状动脉成像诊断支架内再狭窄的敏感性、特异性、阳性预测值和阴性预测值分别为93％、89％、54％和99％.直径≥3.0 rmm支架与直径＜3.0 mm支架成像质量为优质级和中等级的比例(分别为56％比27％,P＜0.01；25％比49％,P＜0.05)及诊断符合率(95％比78％,P＜0.05)差异有统计学意义；结构厚度＜140 μm支架与结构厚度≥140 μm支架成像质量为劣质级比例(12％比45％,P＜0.01)及诊断符合率(94％比76％,P＜0.05)的差异有统计学意义；分叉及套叠支架与单支架成像质量为劣质级的比例差异有统计学意义(36％比17％,P＜0.05),为优质级、中等级的比例(36％比49％,27％比34％)及诊断符合率(86％比90％)的差异均无统计学意义(P均＞0.05)；心室率≥65次/min患者与心室率＜65次/min患者的支架成像质量(优质级、中等级和劣质级的比例分别为53％比40％、26％比39％和21％比21％)及诊断符合率(91％比88％)差异均无统计学意义(P均＞0.05).结论320层CT冠状动脉成像可有选择地应用于诊断支架内再狭窄,对大直径、薄结构支架的成像质量和诊断性能较高.
目的 以冠狀動脈造影檢查結果為標準,評價320層CT冠狀動脈成像診斷冠狀動脈支架內再狹窄的臨床價值.方法 採用前瞻性研究方法,入選冠狀動脈支架置入術後的冠心病患者69例.先後行320層CT冠狀動脈成像及冠狀動脈造影檢查,併以冠狀動脈造影定量分析結果為標準,評價320層CT冠狀動脈成像診斷冠狀動脈支架內再狹窄的敏感性、特異性、暘性預測值及陰性預測值.對CT冠狀動脈成像質量進行分級,併分析支架直徑、結構厚度、數量以及心室率對CT冠狀動脈成像質量和診斷性能的影響.結果69例患者共置入110枚支架,經冠狀動脈造影證實其中14枚存在支架內再狹窄,而320層CT冠狀動脈成像準確診斷支架內再狹窄13枚,漏診1枚,高估狹窄程度5枚,另有6枚無再狹窄的支架因圖像無法觀測而判定為支架內再狹窄.320層CT冠狀動脈成像診斷支架內再狹窄的敏感性、特異性、暘性預測值和陰性預測值分彆為93％、89％、54％和99％.直徑≥3.0 rmm支架與直徑＜3.0 mm支架成像質量為優質級和中等級的比例(分彆為56％比27％,P＜0.01；25％比49％,P＜0.05)及診斷符閤率(95％比78％,P＜0.05)差異有統計學意義；結構厚度＜140 μm支架與結構厚度≥140 μm支架成像質量為劣質級比例(12％比45％,P＜0.01)及診斷符閤率(94％比76％,P＜0.05)的差異有統計學意義；分扠及套疊支架與單支架成像質量為劣質級的比例差異有統計學意義(36％比17％,P＜0.05),為優質級、中等級的比例(36％比49％,27％比34％)及診斷符閤率(86％比90％)的差異均無統計學意義(P均＞0.05)；心室率≥65次/min患者與心室率＜65次/min患者的支架成像質量(優質級、中等級和劣質級的比例分彆為53％比40％、26％比39％和21％比21％)及診斷符閤率(91％比88％)差異均無統計學意義(P均＞0.05).結論320層CT冠狀動脈成像可有選擇地應用于診斷支架內再狹窄,對大直徑、薄結構支架的成像質量和診斷性能較高.
목적 이관상동맥조영검사결과위표준,평개320층CT관상동맥성상진단관상동맥지가내재협착적림상개치.방법 채용전첨성연구방법,입선관상동맥지가치입술후적관심병환자69례.선후행320층CT관상동맥성상급관상동맥조영검사,병이관상동맥조영정량분석결과위표준,평개320층CT관상동맥성상진단관상동맥지가내재협착적민감성、특이성、양성예측치급음성예측치.대CT관상동맥성상질량진행분급,병분석지가직경、결구후도、수량이급심실솔대CT관상동맥성상질량화진단성능적영향.결과69례환자공치입110매지가,경관상동맥조영증실기중14매존재지가내재협착,이320층CT관상동맥성상준학진단지가내재협착13매,루진1매,고고협착정도5매,령유6매무재협착적지가인도상무법관측이판정위지가내재협착.320층CT관상동맥성상진단지가내재협착적민감성、특이성、양성예측치화음성예측치분별위93％、89％、54％화99％.직경≥3.0 rmm지가여직경＜3.0 mm지가성상질량위우질급화중등급적비례(분별위56％비27％,P＜0.01；25％비49％,P＜0.05)급진단부합솔(95％비78％,P＜0.05)차이유통계학의의；결구후도＜140 μm지가여결구후도≥140 μm지가성상질량위렬질급비례(12％비45％,P＜0.01)급진단부합솔(94％비76％,P＜0.05)적차이유통계학의의；분차급투첩지가여단지가성상질량위렬질급적비례차이유통계학의의(36％비17％,P＜0.05),위우질급、중등급적비례(36％비49％,27％비34％)급진단부합솔(86％비90％)적차이균무통계학의의(P균＞0.05)；심실솔≥65차/min환자여심실솔＜65차/min환자적지가성상질량(우질급、중등급화렬질급적비례분별위53％비40％、26％비39％화21％비21％)급진단부합솔(91％비88％)차이균무통계학의의(P균＞0.05).결론320층CT관상동맥성상가유선택지응용우진단지가내재협착,대대직경、박결구지가적성상질량화진단성능교고.
Objective To evaluate the diagnostic accuracy of 320-slice CT coronary angiography (CTA) in the evaluation of in-stent restenosis (ISR,≥ 50％ luminal narrowing ) in comparison with quantitative coronary angiography (CAG).Methods A total of 69 patients with previous stent implantation who underwent both CTA and CAG were prospectively included.We assessed diagnostic valve for ISR with CTA in comparison with CAG.Results A total of 110 stents were implanted in these patients.CAG identified 14 ISR.CTA correctly identified 13 1SR and misdiagnosed 5 ISR in stents without ISR.Besides,6 stents could not be evaluated by CTA due to unsatisfied image quality.Accordingly,sensitivity,specificity,positive and negative predictive value of CTA for diagnosing ISR were 93％,89％,54％ and 99％,respectively.The image quality of CTA was significantly better in larger stents (percentages of good and moderate stent image of ≥ 3.0 mm and ＜3.0 mm:56％ vs.27％,25％ vs.49％ ) and which was linked with better diagnostic coincidence rate(95％ vs.78％ )for larger stents.The image quality of CTA was significantly better in stents with thinner stent strut thickness ( percentages of poor CTA stent image quality of stent strut thickness ＜ 140 μm and ≥ 140 μm:12％ vs.45％,P ＜ 0.01 ) and which was associated with better diagnostic coincidence rate for stents with thinner stent strut thickness (94％ vs.76％,P ＜0.05).The image quality of CTA was also significantly better in single stent ( percentages of poor CTA stent image quality of single stent vs.overlap and dedicated stent:17％ vs.36％,P ＜ 0.05 ).However,heart rate ( ≥65 beats/min vs.＜65 beats/min) during CTA acquisition was not associated with image quality and the diagnostic coincidence rate ( all P ＞ 0.05 ).Conclusions Our results indicate that 320-slice CTA allows accurate noninvasive assessment of significant in-stent restenosis in selected patients.Stents with a large diameter and thin struts are associated with better image quality and higher diagnostic accuracy.
