CAJ | 학술논문

目的：探讨患者心率、支架直径及支架壁厚度对64排螺旋CT冠状动脉造影（CTA）图像质量的影响。方法回顾性分析41例冠状动脉支架置入术患者64排螺旋C T冠状动脉造影图像，分析患者心率、支架直径及支架壁厚度对图像质量的影响，并与常规冠状动脉造影（CAG）金标准比较，评价CTA诊断支架内再狭窄（ISR）的准确性。结果本组41例患者共置入不锈钢药物洗脱支架82枚，CAG检出10枚（12．2％）发生ISR ，14枚支架因图像质量差CTA无法评价。在可评估的68枚支架中：心率＜70次／min有65枚（95．6％），直径支架≥3．0mm者54枚（79．4％），支架壁厚度＜140μm者53枚（77．9％）。在不可评估的14枚支架中：心率≥70次／min有12枚（85．7％），支架直径＜3．0mm 有12枚（85.7％），支架壁厚度≥140μm者有13枚（92．9％）。68枚支架中，C A G检出6枚IS R ，而C T A发现7枚IS R ，其中2枚为假阳性，1枚假阴性，C T A对IS R的的诊断敏感性、特异性、阳性预测值和阴性预测值分别为83．3％、96．8％、71．4％和98．4％。结论64排螺旋CT冠脉造影能准确评价冠状动脉支架内再狭窄，患者心率、支架直径及支架壁厚度影响CTA图像质量，慢心率、薄壁、大直径支架的可评估性更好。
목적：탐토환자심솔、지가직경급지가벽후도대64배라선CT관상동맥조영（CTA）도상질량적영향。방법회고성분석41례관상동맥지가치입술환자64배라선C T관상동맥조영도상，분석환자심솔、지가직경급지가벽후도대도상질량적영향，병여상규관상동맥조영（CAG）금표준비교，평개CTA진단지가내재협착（ISR）적준학성。결과본조41례환자공치입불수강약물세탈지가82매，CAG검출10매（12．2％）발생ISR ，14매지가인도상질량차CTA무법평개。재가평고적68매지가중：심솔＜70차／min유65매（95．6％），직경지가≥3．0mm자54매（79．4％），지가벽후도＜140μm자53매（77．9％）。재불가평고적14매지가중：심솔≥70차／min유12매（85．7％），지가직경＜3．0mm 유12매（85.7％），지가벽후도≥140μm자유13매（92．9％）。68매지가중，C A G검출6매IS R ，이C T A발현7매IS R ，기중2매위가양성，1매가음성，C T A대IS R적적진단민감성、특이성、양성예측치화음성예측치분별위83．3％、96．8％、71．4％화98．4％。결론64배라선CT관맥조영능준학평개관상동맥지가내재협착，환자심솔、지가직경급지가벽후도영향CTA도상질량，만심솔、박벽、대직경지가적가평고성경호。
Objective To investigate factors affecting the image quality of coronary angiography (CTA) with 64‐detector spiral CT after coronary stent implantation .Methods 41 consecutive patients with previous cononary stent implantation with 82 stainless steel drug‐eluting stents were included in this study to analyze whether the patient’s heart rate ,the stent diameter and the stent wall thickness affected the CTA image quality .And then ,we evaluated the accuracy of CTA in the diagnosis of in‐stent restenosis (ISR) compared with the coronary angiography (CAG) as the“gold standard” .Results 10 ISRs were detected by CAG in the 82 stents ,14 stents could not be evaluated by CTA because of poor image quality .Of 68 evaluable stents ,there were 65 stents (95 .6% ) with the paten’s heart rate <70 beats per minute(bpm) ,54 stents (79.4% ) with stent diameter ≥3 .0 mm ,and 53 stents (77 .9% ) with stent wall thickness <140μm .14 stents were un‐evaluable ,of which there were 12 stents (85 .7% ) in patients with heart rate≥70 bpm and 12 with stent diameter <3.0 mm ,13 stents (92 .9% ) with wall thickness ≥140μm .Of 68 stents which could be assessed by CTA ,6 ISRs were detec‐ted by CAG ,and 7 by CTA which included 2 false positive and 1 false negative ,and the diagnostic sensitivity ,specificity , positive predictive value and negative predictive value of ISR with CTA were 83 .3% ,96 .8% ,71 .4% and 98 .4% ,and the difference was no statistically significant ( P >0 .05) compared with CAG .Conclusion 64‐detector Spiral CT Coronary Angiography can accurately evaluate in‐stent restenosis of coronary artery .The heart rate of the patient ,stent diameter and wall thickness of stent can affect image quality ,the slower heart rate ,thinner‐walled and large diameter stent can be better assessed .