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目的评价心电门控的64层螺旋CT检测急性冠脉综合征(ACS)患者冠状动脉内斑块成分的价值及其局限性。方法对经选择性冠状动脉造影证实为冠心病的85例患者(ACS组49例,非ACS组36例)进行64层螺旋CT冠状动脉成像,对主要冠状动脉内的斑块成分进行评价。斑块的CT值用Hounsfield units(HU)表示。结果两组之间的斑块数量无差别,在靶病变中ACS组斑块的平均CT值(24±15)HU低于非ACS患者斑块的平均CT值(86±14)HU,两者比较差异有统计学意义(P<0.01)。在非靶病变血管有斑块的40例ACS患者中,靶病变冠脉节段的斑块CT值(20±18)HU低于非靶病变冠脉节段的斑块CT值(47±17)HU,两者比较差异有统计学意义(P<0.01)。ACS组Ⅱ型斑块CT值(25±13)HU低于Ⅰ型斑块(46±17)HU,同时,非ACS组Ⅱ型斑块CT值(64±10)HU也低于Ⅰ型斑块(88±14)HU,两者比较差异均有统计学意义(P<0.01)。在Ⅰ型病变和Ⅱ型病变中,ACS组斑块CT值均低于非ACS组,两者比较差异均有统计学意义(P<0.01)。结论64层螺旋CT能够有效检测冠心病患者冠状动脉斑块的成分并提示其稳定性受到图像质量和评价方法的影响,其临床应用具有一定的局限性。
Objective To evaluate the value and limitations of ECG-gated 64-slice spiral CT in detecting intracoronary plaque components in patients with acute coronary syndrome (ACS). Methods Totally 85 patients with coronary artery disease who underwent selective coronary angiography (ACS group, 49 cases, non-ACS group, 36 cases) underwent 64-slice spiral CT coronary angiography to evaluate the major intracoronary plaque components. The plaque CT values are expressed in Hounsfield units (HU). Results There was no difference in the number of plaques between the two groups. The average CT value (24 ± 15) HU in the ACS group was lower than that in the non-ACS patients (86 ± 14) HU The difference was statistically significant (P <0.01). Among 40 ACS patients with non-target vessel lesions, the CT value of target lesion coronary arteries was (20 ± 18) HU lower than that of non-target lesion coronary arteries (47 ± 17 ) HU, the difference between the two was statistically significant (P <0.01). The CT value of type Ⅱ plaque in ACS group (25 ± 13) HU was lower than that of type Ⅰ plaque (46 ± 17) HU, while the CT value of type Ⅱ plaque in non-ACS group (64 ± 10) HU was also lower than that in type Ⅰ plaque (88 ± 14) HU, the difference was statistically significant (P <0.01). In type Ⅰ and type Ⅱ lesions, the CT value of plaque in ACS group was lower than that in non-ACS group, the difference was statistically significant (P <0.01). Conclusion 64-slice spiral CT can effectively detect coronary plaque components in patients with coronary heart disease and suggest that its stability is affected by image quality and evaluation methods. The clinical application has some limitations.