64层螺旋CT评估冠状动脉斑块的位置分布、性质及稳定性的应用价值
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摘要
目的探讨64层螺旋CT评估冠状动脉斑块的位置分布、性质及稳定性的应用价值。方法回顾性分析我院收治的初诊为冠状动脉性心脏病(Coronaryheart disease,CHD)患者157例,均接受64层螺旋CT检查,纳入观察组。另选同期157例非急性冠脉综合征患者,纳入对照组。两组患者冠状动脉扫描原始数据传至后处理工作站,由2名CT医生使用心脏标准算法对图像进行重建,选40%、46%、70%、75%收缩期,找出质量最佳、图片效果最好的图像进行处理,然后重建最大密度投影、曲面重建、多平面重建,测量斑块CT值。结果观察组共检出157个斑块,检出率100%。对照组患者中共检出124斑块,检出率78.98%,观察组冠状动脉软斑块、混合斑块检查率显著高于对照组,钙化斑块检出低于对照组(P<0.05)。观察组与对照组共分析520段冠状动脉。观察组患者中动脉狭窄共175段,其中89段为重度狭窄,46段中度狭窄,40段轻度狭窄。对照组患者中动脉狭窄有201段,其中24段为重度狭窄,中度狭窄19段,轻度狭窄158段。观察组冠状动脉狭窄率高于对照组(P<0.05),观察组重度冠状动脉狭窄率、正常率显著高于对照组(P<0.05)。64层螺旋CT评价狭窄程度轻度、中度、重度灵敏性分别为73.24%、80.78%、87.54%,狭窄程度轻度、中度、重度特异性95.69%、96.54%、97.24%各项指标略有差异,但仍有较高的准确性及特异性。157枚斑块数量由多到少分布:LAD2、LAD1、RCA1/D1、LCX1、LM/LAD3、PLV/PDA/LCX2、RCA3、D2/OM、RCA2。斑块类型(钙化斑块、非钙化斑块、混合斑块)与管腔狭窄程度(轻、中、重度)有关(P<0.05)。结论64层螺旋CT可有效评估冠状动脉斑块的位置分布、性质及稳定性,指导临床治疗。
Objective To investigate the value of 64-slice spiral CT in the evaluation of the location, properties and stability of coronary plaque. Methods The clinical data of 157 cases of CHD(observation group) and 157 cases of non-acute coronary syndrome(control group) underwent 64-slice spiral CT examinations in our hospital were analyzed retrospectively. Images were reconstructed by maximum intensity projection(MIP), curved planar reformation(CPR), multiple planar reformation(MPR) methods. Then the CT value of coronary plaque was calculated based on the digital image postprocessing algorithms. Results The total detection rate of plaque was 100%(157 cases) in the observation group and 78.98%(124) in the control group; the observation group had higher detection rate of soft plaque and mixed plaque as well as lower detection rate of calcified plaque than those of the control group(P<0.05), a total of 520 plaques were checked, including 157 cases of arteriostenosis in observation group and 201 cases of arteriostenosis in the control group. The coronary artery stenosis rate in the observation group was higher than that in the control group(P<0.05). The coronary artery stenosis was severe in 89 cases, moderate in 46 cases and mild in 40 cases in the observation group, and these were 24 cases, 19 cases and 158 cases in the control group, respectively. The severe coronary artery stenosis rate and normal rate in the observation group were significantly higher than those in the control group(P<0.05). The sensitivity and specificity of 64-slice spiral CT in the evaluation of mild, moderate and severe coronary artery stenosis were 73.24%/95.69%, 80.78%/96.54% and 87.54%/97.24%. The distribution of the plaques ranked in a descending order was LAD2, LAD1, RCA1/D1, LCX1, LM/LAD3, PLV/PDA/LCX2, RCA3, D2/OM, RCA2. The types of plaque(calcified, noncalcified, mixed) were related to the coronary artery stenosis degree(mild, moderate and severe)(P<0.05). Conclusion 64-slice spiral CT can evaluate the location, properties and stability of coronary plaque effectively, which is worthy of clinical application.
Objective To investigate the value of 64-slice spiral CT in the evaluation of the location, properties and stability of coronary plaque. Methods The clinical data of 157 cases of CHD(observation group) and 157 cases of non-acute coronary syndrome(control group) underwent 64-slice spiral CT examinations in our hospital were analyzed retrospectively. Images were reconstructed by maximum intensity projection(MIP), curved planar reformation(CPR), multiple planar reformation(MPR) methods. Then the CT value of coronary plaque was calculated based on the digital image postprocessing algorithms. Results The total detection rate of plaque was 100%(157 cases) in the observation group and 78.98%(124) in the control group; the observation group had higher detection rate of soft plaque and mixed plaque as well as lower detection rate of calcified plaque than those of the control group(P<0.05), a total of 520 plaques were checked, including 157 cases of arteriostenosis in observation group and 201 cases of arteriostenosis in the control group. The coronary artery stenosis rate in the observation group was higher than that in the control group(P<0.05). The coronary artery stenosis was severe in 89 cases, moderate in 46 cases and mild in 40 cases in the observation group, and these were 24 cases, 19 cases and 158 cases in the control group, respectively. The severe coronary artery stenosis rate and normal rate in the observation group were significantly higher than those in the control group(P<0.05). The sensitivity and specificity of 64-slice spiral CT in the evaluation of mild, moderate and severe coronary artery stenosis were 73.24%/95.69%, 80.78%/96.54% and 87.54%/97.24%. The distribution of the plaques ranked in a descending order was LAD2, LAD1, RCA1/D1, LCX1, LM/LAD3, PLV/PDA/LCX2, RCA3, D2/OM, RCA2. The types of plaque(calcified, noncalcified, mixed) were related to the coronary artery stenosis degree(mild, moderate and severe)(P<0.05). Conclusion 64-slice spiral CT can evaluate the location, properties and stability of coronary plaque effectively, which is worthy of clinical application.
引文
[1]韩迎春,樊刚,曹文广,等.64层螺旋CT冠脉成像与DSA血管造影在疾病中诊断价值的比较分析[J].中国CT和MRI杂志,2016, 14(1):56-58.
[2]侯铁,邓玉云,杨光,等. 128层螺旋CT冠状动脉造影在评估冠脉支架置入后随访中的临床应用价值[J].中国实验诊断学,2016, 20(5):748-749.
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[6]喻红,肖寄余.6 4层螺旋CT在诊断冠状动脉斑块及狭窄中的应用价值[J].中国医师杂志,2017,19(1):128-130.
[7]孙毅,周海军,方婷,等.运用128层宝石能谱CT探讨斑块性质与心绞痛类型相关性研究[J].中国医师杂志,2017, 19(5):697-700.
[8]吴震,宋伟,方颖.多层螺旋CT冠脉成像评估冠脉狭窄病变的临床价值[J].中国CT和MRI杂志,2016,14(6):25-27.
[9]霍连营,王翠芹,姜秋燕. 128层螺旋CT冠状动脉成像与常规冠状动脉造影对照分析[J].实用心脑肺血管病杂志,2016, 10(b04):52-54.
[10]黄勇,丁仁福,符惠宏,等.128层螺旋CT冠脉成像在诊断及分级评价冠心病的临床价值[J].医学影像学杂志,2016, 26(6):1 150-1 152.
[11]黄乐生,刘金丰,刘海龙,等.不同心率对于64 0层螺旋CT冠状动脉成像质量及相关辐射剂量的影响[J].中国CT和MRI杂志,2016, 14(1):52-55.
[12]姚福会.64排螺旋CT冠状动脉CTA图像质量影响因素分析[J].国际心血管病杂志,2017,10(A01):224-225.
[15]Lee K Y,Hwang B H,Kim T H,et al.CT Angiography Images of Coronary Artery Stenosis Provide a Better Prediction of Risk Than Traditional Risk Factors in Asymptomatic Individuals With Type 2 Diabetes:A Long-term Study of Clinical Outcomes[J].Diabetes Care,2017,40(9):1241.
[2]侯铁,邓玉云,杨光,等. 128层螺旋CT冠状动脉造影在评估冠脉支架置入后随访中的临床应用价值[J].中国实验诊断学,2016, 20(5):748-749.
[3]丁辉.64排螺旋CT冠脉成像(CTA)在冠心病诊断中的应用价值分析[J].中国实验诊断学,2016,22(2):224-226.
[4]解晓江,肖学慧,刘艳阳,等.64层螺旋CT联合尿酸、同型半胱氨酸评估冠心病患者冠状动脉斑块稳定性的临床价值[J].疑难病杂志,2016,15(1):14-17.
[5]李红.双源螺旋CT诊断冠脉易损斑块的应用价值[J].中国CT和MRI杂志,2016, 14(1):42-45.
[6]喻红,肖寄余.6 4层螺旋CT在诊断冠状动脉斑块及狭窄中的应用价值[J].中国医师杂志,2017,19(1):128-130.
[7]孙毅,周海军,方婷,等.运用128层宝石能谱CT探讨斑块性质与心绞痛类型相关性研究[J].中国医师杂志,2017, 19(5):697-700.
[8]吴震,宋伟,方颖.多层螺旋CT冠脉成像评估冠脉狭窄病变的临床价值[J].中国CT和MRI杂志,2016,14(6):25-27.
[9]霍连营,王翠芹,姜秋燕. 128层螺旋CT冠状动脉成像与常规冠状动脉造影对照分析[J].实用心脑肺血管病杂志,2016, 10(b04):52-54.
[10]黄勇,丁仁福,符惠宏,等.128层螺旋CT冠脉成像在诊断及分级评价冠心病的临床价值[J].医学影像学杂志,2016, 26(6):1 150-1 152.
[11]黄乐生,刘金丰,刘海龙,等.不同心率对于64 0层螺旋CT冠状动脉成像质量及相关辐射剂量的影响[J].中国CT和MRI杂志,2016, 14(1):52-55.
[12]姚福会.64排螺旋CT冠状动脉CTA图像质量影响因素分析[J].国际心血管病杂志,2017,10(A01):224-225.
[15]Lee K Y,Hwang B H,Kim T H,et al.CT Angiography Images of Coronary Artery Stenosis Provide a Better Prediction of Risk Than Traditional Risk Factors in Asymptomatic Individuals With Type 2 Diabetes:A Long-term Study of Clinical Outcomes[J].Diabetes Care,2017,40(9):1241.