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目的探讨16排螺旋 CT(16-muhidetector spiral computed tomography,16-MDCT)检测和区分冠状动脉斑块的准确性。方法对2005年8月至2006年3月68例拟诊为冠心病的患者先行16-MDCT 检查,4天内再行定量冠状动脉造影(QCA)和血管内超声(IVUS)检查,冠状动脉血管腔直径狭窄(DS)≥50%定义为有意义的狭窄,分别测量斑块的 CT 密度,单位为 CT 值(Hounsfield units,HU),根据冠状动脉斑块的 CT 值区分斑块性质并作出分类:(1)软斑块:CT 值为≤50 HU;(2)纤维斑块(中等斑块):CT 值为50～119 HU;(3)钙化斑块≥120 HU。结果在112段16-MDCT 和 QCA 均诊断为冠状动脉狭窄≥50%的病变中,其敏感性为91.8%(112/122),特异性为97.8%(556/568),共96段有意义的狭窄病变纳入研究,分别位于左前降支57段,左回旋支17段,右冠状动脉14段,左主干8段。IVUS 发现软斑块21个(21.9%)、纤维斑块36个(37.5%)、钙化斑块38个(39.5%),混合性斑块(纤维钙化斑块)1个(1.1%),16-MDCT 发现软斑块20个,平均 CT 值(11±36)HU(-27～42 HU)、纤维斑块37个,平均 CT 值(83±20)HU(58～105 HU)、钙化斑块39个,平均 CT 值(292±80)HU(167～530 HU),差异有统计学意义(P<0.05)。结论无创性16排螺旋 CT 冠状动脉成像技术不仅可诊断冠状动脉狭窄病变,同时对区分钙化斑块及非钙化斑块有较高的诊断价值。
Objective To investigate the accuracy of 16-muhidetector spiral computed tomography (16-MDCT) in detecting and differentiating coronary plaque. Methods Sixty-six patients with suspected CHD were examined by 16-MDCT from August 2005 to March 2006. QCA and IVUS were performed within 4 days. Coronary artery blood vessels The diameter of stenosis (DS) ≥50% was defined as significant stenosis, and the CT density of the plaques was measured respectively in Hounsfield units (HU). According to the CT value of coronary plaque, the plaque characteristics were distinguished and classified: (1) soft plaque: CT value ≤ 50 HU; (2) fibrous plaque (middle plaque): CT value of 50 ~ 119 HU; (3) calcified plaque ≥ 120 HU. Results Of the 112 lesions diagnosed by 16-MDCT and QCA with ≥50% of coronary artery stenosis, the sensitivity was 91.8% (112/122) and the specificity was 97.8% (556/568) Of the narrow lesions were included in the study, were located in the left anterior descending artery 57, left circumflex artery 17, right coronary artery 14, left main 8. IVUS found 21 (21.9%) soft plaques, 36 (37.5%) fibrous plaques, 38 (39.5%) calcified plaques, 1 (1.1%) mixed plaque MDCT revealed 20 soft plaques with an average CT value of (11 ± 36) HU (-27 ~ 42 HU), 37 fibrous plaques, and an average CT value of (83 ± 20) HU (58-105 HU) There were 39 blocks with a mean CT value of (292 ± 80) HU (167-530 HU), with significant difference (P <0.05). Conclusion Noninvasive 16-slice spiral CT coronary angiography can not only diagnose coronary artery stenosis, but also has high diagnostic value in distinguishing calcified plaque from non-calcified plaque.