泰山医学院学报
泰山醫學院學報
태산의학원학보
JOURNAL OF TAISHAN MEDICAL COLLEGE
2015年
7期
729-732
,共4页
体层摄影%X 线计算机%发射型计算机%单光子%冠状动脉血管成像%心肌缺血
體層攝影%X 線計算機%髮射型計算機%單光子%冠狀動脈血管成像%心肌缺血
체층섭영%X 선계산궤%발사형계산궤%단광자%관상동맥혈관성상%심기결혈
tomography%X-ray computed%emission-computed%single-photon%coronary angiography%myocardial is-chemia
目的：评价 CT 冠状动脉成像（冠脉 CTA）在诊断致心肌缺血性冠状动脉狭窄中的临床价值。方法因冠心病或可疑冠心病而行冠脉 CTA、传统冠状动脉造影（CCA）和心肌灌注显像（MPI）患者30例，三项检查均于1个月内完成。冠脉 CTA 采用256层极速 CT，以冠状动脉管腔狭窄≥50%作为有血流动力学意义病变，并与 CCA 结果比较；以心肌 CT 强化减低及变薄作为心肌梗死表现。MPI 采用两日法运动负荷或潘生丁负荷 SPECT 99 Tcm-MIBI显像，根据心肌灌注缺损的部位推断相应冠状动脉病变血管。结果 CCA 检出18例有≥50%的冠状动脉狭窄，共33支血管，51个节段，其中25个节段（49%）位于冠状动脉的远段与分支。7例支架植入术后患者共检出金属支架14枚，其中1枚支架内再狭窄≥50%，余均通畅。CTA 可评估冠状动脉节段85%，不可评估节段15%。冠脉 CTA检出全部节段和可评估节段≥50%狭窄病变的灵敏度、特异性、阳性预测值（PPV）、阴性预测值（ NPV）分别为43%，95%，58%，92%和59%，95%，58%，95%。冠脉 CTA 检出≥50%狭窄冠状动脉的灵敏度、特异性、PPV、NPV分别为45%，89%，60%，81%。MPI 检出可逆性缺损（心肌缺血）患者5例，不可逆性缺损（心肌梗死）3例。CCA与冠脉 CTA 检出可逆性缺损的灵敏度、特异性、PPV、NPV 分别为100%，77%，17%，100%和57%，81%，12%，98%。3例不可逆性缺损患者，冠脉 CTA 均发现相应区域内有心肌 CT 强化减低与心肌变薄。结论冠脉 CTA 诊断致心肌缺血性冠状动脉病变有较高的 NPV，中等的灵敏度和特异性，但 PPV 却较低；MPI 目前仍然是评价冠状动脉血流动力学相关性狭窄的必要手段。
目的：評價 CT 冠狀動脈成像（冠脈 CTA）在診斷緻心肌缺血性冠狀動脈狹窄中的臨床價值。方法因冠心病或可疑冠心病而行冠脈 CTA、傳統冠狀動脈造影（CCA）和心肌灌註顯像（MPI）患者30例，三項檢查均于1箇月內完成。冠脈 CTA 採用256層極速 CT，以冠狀動脈管腔狹窄≥50%作為有血流動力學意義病變，併與 CCA 結果比較；以心肌 CT 彊化減低及變薄作為心肌梗死錶現。MPI 採用兩日法運動負荷或潘生丁負荷 SPECT 99 Tcm-MIBI顯像，根據心肌灌註缺損的部位推斷相應冠狀動脈病變血管。結果 CCA 檢齣18例有≥50%的冠狀動脈狹窄，共33支血管，51箇節段，其中25箇節段（49%）位于冠狀動脈的遠段與分支。7例支架植入術後患者共檢齣金屬支架14枚，其中1枚支架內再狹窄≥50%，餘均通暢。CTA 可評估冠狀動脈節段85%，不可評估節段15%。冠脈 CTA檢齣全部節段和可評估節段≥50%狹窄病變的靈敏度、特異性、暘性預測值（PPV）、陰性預測值（ NPV）分彆為43%，95%，58%，92%和59%，95%，58%，95%。冠脈 CTA 檢齣≥50%狹窄冠狀動脈的靈敏度、特異性、PPV、NPV分彆為45%，89%，60%，81%。MPI 檢齣可逆性缺損（心肌缺血）患者5例，不可逆性缺損（心肌梗死）3例。CCA與冠脈 CTA 檢齣可逆性缺損的靈敏度、特異性、PPV、NPV 分彆為100%，77%，17%，100%和57%，81%，12%，98%。3例不可逆性缺損患者，冠脈 CTA 均髮現相應區域內有心肌 CT 彊化減低與心肌變薄。結論冠脈 CTA 診斷緻心肌缺血性冠狀動脈病變有較高的 NPV，中等的靈敏度和特異性，但 PPV 卻較低；MPI 目前仍然是評價冠狀動脈血流動力學相關性狹窄的必要手段。
목적：평개 CT 관상동맥성상（관맥 CTA）재진단치심기결혈성관상동맥협착중적림상개치。방법인관심병혹가의관심병이행관맥 CTA、전통관상동맥조영（CCA）화심기관주현상（MPI）환자30례，삼항검사균우1개월내완성。관맥 CTA 채용256층겁속 CT，이관상동맥관강협착≥50%작위유혈류동역학의의병변，병여 CCA 결과비교；이심기 CT 강화감저급변박작위심기경사표현。MPI 채용량일법운동부하혹반생정부하 SPECT 99 Tcm-MIBI현상，근거심기관주결손적부위추단상응관상동맥병변혈관。결과 CCA 검출18례유≥50%적관상동맥협착，공33지혈관，51개절단，기중25개절단（49%）위우관상동맥적원단여분지。7례지가식입술후환자공검출금속지가14매，기중1매지가내재협착≥50%，여균통창。CTA 가평고관상동맥절단85%，불가평고절단15%。관맥 CTA검출전부절단화가평고절단≥50%협착병변적령민도、특이성、양성예측치（PPV）、음성예측치（ NPV）분별위43%，95%，58%，92%화59%，95%，58%，95%。관맥 CTA 검출≥50%협착관상동맥적령민도、특이성、PPV、NPV분별위45%，89%，60%，81%。MPI 검출가역성결손（심기결혈）환자5례，불가역성결손（심기경사）3례。CCA여관맥 CTA 검출가역성결손적령민도、특이성、PPV、NPV 분별위100%，77%，17%，100%화57%，81%，12%，98%。3례불가역성결손환자，관맥 CTA 균발현상응구역내유심기 CT 강화감저여심기변박。결론관맥 CTA 진단치심기결혈성관상동맥병변유교고적 NPV，중등적령민도화특이성，단 PPV 각교저；MPI 목전잉연시평개관상동맥혈류동역학상관성협착적필요수단。
Objective:To investigate the diagnostic value of coronary CT angiography(CTA)in detecting ischemia-in-ducing stenosis by comparing with myocardial perfusion imaging(MPI). Methods:Thirty patients with suspected or known coronary artery disease were retrospectively studied. They received coronary CTA,conventional coronary angiography (CCA)and MPI within one month. Coronary CTA was performed using 256-slice spiral computed tomography. A stenosis was classified as significant if the mean lumen diameter reduction was 50% . The coronary CTA results were documented to 13 coronary segments(modified AHA classification),and then were allocated to 4 coronary arteries(LM,LAD,LCX, RCA). The myocardial regions with decreased CT attenuation and wall thinning of left ventricular wall were recorded as in-farcted areas. A two-day stress / rest MPI protocol was performed to all patients using 99 Tcm-MIBI SPECT. Perfusion de-fects on MPI were allocated to corresponding coronary arteries according to the coronary perfusion type of subjects. Results:Forty - eight coronary segments with significant stenosis(allocating to 33cronary vessels)were detected among 18 patients by CCA(1-,2-,3-vessel disease in 11,6,7 patients,respectively). Total 14 intracoronary metal stents allocating to 13 segments among 7 patients were detected. One in-stent restenosis was verified by CCA. 85% percent of the total segments were evaluable,and 15% was unevaluable on coronary CTA. On segment-based analysis,the sensitivity,specificity,posi-tive prediction value(PPV),negative prediction value(NPV)of coronary CTA in detecting significant stenosis for all seg-ments and evaluable ones were 43% ,95% ,58% ,92% and 59% ,95% ,58% ,95% respectively. On vessel-based a-nalysis,the sensitivity,specificity,PPV and NPV were 45% ,89% ,60% and 81% respectively,for coronary CTA to correctly detect coronary vessels with at least one significant stenosis or rule out the presence of any significant stenosis per vessel. Five reversible and 3 fixed perfusion defects were identified by MPI in 8 of 30 patients. The sensitivity,specificity, PPV and NPV of CCA and coronary CTA in detecting reversible perfusion defects( myocardial ischemia)were 100% , 77% ,17% ,100% and 57% ,81% ,12% ,98% ,respectively. All of the 3 patients with fixed defects(myocardial in-farction)demonstrated decreased CT attenuation and wall thinning in the corresponding myocardial regions. Conclusion:Coronary CTA has moderate sensitivity and specificity,high NPV,but lower PPV,in predicting myocardial ischemia. MPI remains mandatory for evaluating the functional relevance of coronary stenosis.
