CAJ | 학술논문

目的：探讨 HDCT血管造影(HDCTA)显示冠状动脉支架内再狭窄(ISR)的能力。方法回顾性分析冠状动脉支架术后行CAG及 HDCTA 93例,以CAG定量分析结果为参照,评价 HDCTA诊断冠状动脉 ISR的敏感性、特异性、阳性预测值及阴性预测值和诊断符合率。对CT冠状动脉成像质量进行评分,分析 HDCTA 对左前降支冠状动脉节段的支架显示能力,支架直径以及心率对 HDCTA成像质量和诊断性能的影响。结果93例159枚支架中,CAG证实21枚存在ISR,HDCTA诊断支架内再狭窄19枚,其中3枚狭窄程度被高估,另有5枚支架因临近钙化灶等因素而被误判为再狭窄。HDCTA 诊断 ISR 的敏感性、特异性、阳性预测值、阴性预测值及诊断符合率分别为90.5%、96.4%、79.2%、98.5%、95.6%。成像质量为4分的支架75枚(47.1%),3分33枚(20.8%),2分27枚(17%),1分及以下24枚(15.1%)。左前降支近段较中、远段支架、直径≥3.0 mm 较与直径<3.0 mm支架以及心率<66次/min同心率≥66次/min病例支架成像质量差异有统计学意义(P<0.05)。支架直径大、心率慢、支架在血管近端时成像质量更优。结论 HDCTA为一种简便、有效、无创性检查,可用于冠状动脉支架置入术后的随访观察。
목적：탐토 HDCT혈관조영(HDCTA)현시관상동맥지가내재협착(ISR)적능력。방법회고성분석관상동맥지가술후행CAG급 HDCTA 93례,이CAG정량분석결과위삼조,평개 HDCTA진단관상동맥 ISR적민감성、특이성、양성예측치급음성예측치화진단부합솔。대CT관상동맥성상질량진행평분,분석 HDCTA 대좌전강지관상동맥절단적지가현시능력,지가직경이급심솔대 HDCTA성상질량화진단성능적영향。결과93례159매지가중,CAG증실21매존재ISR,HDCTA진단지가내재협착19매,기중3매협착정도피고고,령유5매지가인림근개화조등인소이피오판위재협착。HDCTA 진단 ISR 적민감성、특이성、양성예측치、음성예측치급진단부합솔분별위90.5%、96.4%、79.2%、98.5%、95.6%。성상질량위4분적지가75매(47.1%),3분33매(20.8%),2분27매(17%),1분급이하24매(15.1%)。좌전강지근단교중、원단지가、직경≥3.0 mm 교여직경<3.0 mm지가이급심솔<66차/min동심솔≥66차/min병례지가성상질량차이유통계학의의(P<0.05)。지가직경대、심솔만、지가재혈관근단시성상질량경우。결론 HDCTA위일충간편、유효、무창성검사,가용우관상동맥지가치입술후적수방관찰。
Objective To explore the accuracy of high definition computed tomography angiography (HDCTA)in the evaluation of coronary in-stent restenosis.Methods 93 patients with 159 implanted coronary stents who underwent both HDCTA and CAG were included in the study.The sensitivity,specificity,positive predictive value (PPV),negative predictive value (NPV)and diag-nostic accordance rate of HDCTA were calculated.The imaging quality was analyzed by visual estimation.Possible factors that in-fluenced the diagnostic accuracy of HDCTA were evaluated,which included stent location,stent diameter and heart rate in the pa-tients with left anterior descending branch stents.Results Restenosis was found in 21 stents by CAG and 19 stents by HDCTA.The false positive and false negative were 5 and 3,respectively.Sensitivity,specificity,PPV,NPV and diagnostic accordance rate were 90.5%,96.4%,79.2%,98.5% and 95.6% respectively.The image quality was 4 score in 75 stents (47.1%),3 score in 33 (20.8%),2 score in 27 (17%),≤1 score in 24 (15.1%).The image quality of proximal segments,large stents (≥3.0 mm)and slow heart rate (<66 beast per minute)was significantly better than that of distal segments,small stents (<3.0 mm)and fast heart rate (≥6 6 beast per minute).Conclusion HDCTA is a convenient,efficient and non-invasive method for follow-up after im-plantation of the coronary artery stents.