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目的评价多层CT(MSCT)诊断邻近支架冠状动脉血管段狭窄的价值。方法对2003年8月至2006年12月首都医科大学附属北京朝阳医院心脏中心62例成功经皮冠状动脉介入治疗(PCI)术后(共植入80枚支架)的患者,于随访期同时行MSCT冠状动脉成像和冠状动脉造影(CAG)检查,把两种成像技术对临近支架的冠状动脉血管段狭窄程度的测量结果进行对比。结果80个邻近支架冠状动脉血管段有57段(71.25%)可供研究;不能评价的主要原因是移动伪影(13/23,57%)和严重钙化(8/23,35%)。直径的测量结果,MSCT和CAG比较差异有统计学意义[(2.52±0.7)mm比(2.79±0.73)mm,配对差均值(0.28±0.64)mm,P<0.05]。MSCT正确诊断5个狭窄节段,漏诊1例,其评价邻近支架冠状动脉狭窄的敏感性、特异性、准确度、阳性预测值、阴性预测值分别为83%、93%、93%、56%、98%。结论MSCT诊断邻近支架节段冠状动脉狭窄具有很高的准确度。影响MSCT诊断特性的主要因素是运动伪影和冠状动脉弥漫性钙化。
Objective To evaluate the value of multi-slice CT (MSCT) in the diagnosis of coronary artery stenosis in adjacent stents. Methods From August 2003 to December 2006, 62 patients undergoing successful percutaneous coronary intervention (PCI) in Beijing Chaoyang Hospital Cardiac Center, Capital Medical University from August 2003 to December 2006 were enrolled in this study. During the follow-up period, MSCT coronary angiography and coronary angiography (CAG) were performed to compare the results of two imaging techniques with the degree of coronary artery stenosis near the stent. Results There were 57 segments (71.25%) in coronary artery segments of 80 adjacent scaffolds for study. The main reason for the unobservable coronary arteries was mobile artifact (13 / 23,57%) and severe calcification (8 / 23,35%). The difference of MSCT and CAG between two groups was statistically significant (2.52 ± 0.7) mm (2.79 ± 0.73) mm, and the mean of paired difference was (0.28 ± 0.64) mm, P <0.05. The accuracy, specificity, accuracy, positive predictive value and negative predictive value of MSCT in diagnosing coronary stenosis of adjacent stents were 83%, 93%, 93%, 56% , 98%. Conclusion MSCT has high accuracy in diagnosis of coronary artery stenosis in adjacent scaffold segments. The main factors that influence the diagnostic features of MSCT are motion artifact and diffuse calcification of coronary artery.