64排螺旋CT评价冠状动脉搭桥术后桥血管的初步应用
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摘要
目的:冠状动脉粥样硬化性心脏病( coronary atherosclerotic heart disease)指冠状动脉粥样硬化使得血管管腔狭窄或阻塞,或(和)因冠状动脉功能性改变(痉挛)导致心肌缺血缺氧或坏死引起的心脏病,统称冠状动脉性心脏(coronary heart disease),简称冠心病。冠心病外科治疗主要是冠状动脉搭桥术(coronary artery bypass graft, CABG)为缺血心肌重建血运通道,改善心肌供血供氧,缓解和消除心绞痛症状,改善心肌功能,延长寿命。CABG术后复查主要以X线下的选择性冠状动脉造影(conventional coronaryangiography,CAG)为准,但是该检查费用高、风险大,难以被多数患者所接受。
近年随着CT技术的迅速发展,CT冠状动脉成像(computed tomography coronary angiography,CTA)逐渐成为学术界的研究热点之一,它对通过图像重组可以有效地显示冠状动脉血管树,并准确显示冠状动脉病变。特别是64排螺旋CT(64-slice computed tomography,64-SCT),它对心脏扫描的时间更快,功能软件更完善,对CABG术后患者的危险程度和发展趋势有一定的评估,诊断价值会更大。
方法:选取我院2007年6月～2009年3月门诊复查的CABG术后患者共27例,男17例,女10例,年龄49～78岁,平均(63.6±7.9)岁。搭桥时间至CTA检查时间间隔30～121月,平均(59±18.7)月。所有患者均行64排螺旋CT冠状动脉扫描(64-slice computed tomography coronary angiography,64-SCTA)检查冠状动脉以及冠状动脉术后搭桥血管的病变情况,其中共有10例患者在64-SCTA之后行CAG,5例当时行经皮冠状动脉介入治疗(percutaneous coronary intervention,PCI),1例再次行CABG,其余患者主要以药物治疗为主。参照美国心脏病协会(American Heart Association,AHA)冠状动脉节段划分法,将冠状动脉分为9段,冠状动脉搭桥术治疗后的病人桥血管分为5～6段,血管狭窄依程度分为四级:⑴正常;⑵狭窄程度25～50%为轻度狭窄;⑶狭窄程度50%～75%为中度狭窄;⑷狭窄程度≥75%为重度狭窄。对比分析64-SCTA和CAG的结果。64-SCTA结果由一组影像学专家来分析,以狭窄部位两端的血管直径作为参考值,评价桥血管病变情况,对狭窄程度进行分析及评价。CAG由一组心内科医师报告结果。64-SCTA和CAG两组之间都不知道对方的结果。64-SCTA诊断准确性以CAG结果作为标准,由此计算出敏感性、特异性、阳性预测值、阴性预测值和准确性,并做X2检验比较两种方法的诊断有无差别,计算kappa值查看其一致性。
结果:27例患者均成功接受检查,每位患者大约需要10～15 min完成检查。27例患者均无心律失常,心率为52～85次/分。CTA扫描时间(9.0±1.2)s,屏气时间为12～14s。共发现桥血管78根,其中大隐静脉桥52根,动脉桥23根。共发现427段血管,其中能够满足影像学评价的共392段(占91.80%),35段(占8.20%)无法评价,其中运动伪影10段、严重钙化12段、金属夹伪影13段。LIMA-LAD桥、AO-LAD桥、AO-RCA桥和AO-LCX桥的可评价率分别为(103/115)89.57%、(18/18)100%、(139/150)92.67%、(132/144)91.67%。10例同期行64-SCTA及冠状动脉造影,两者诊断桥血管通畅、轻度狭窄、中度狭窄、重度狭窄的符合率分别为: 97.94%、88.24%、92.31%、90.00%。64-SCTA显示轻度以上狭窄(≥25%)的敏感度和特异度分别为100%和97.94%,准确度为98.51%;64-SCTA显示中度以上狭窄(≥50%)的敏感度和特异度分别为100%和100%,准确度为100%。重度狭窄(≥75%)的敏感度和特异度分别为90.00%和100%,准确度为99.25%。
X2检验,得出0.95 结论:64-SCTA在评价冠心病病人冠状动脉病变及CABG术后桥血管通畅、狭窄和闭塞方面,有很高的准确性,敏感性和特异性,虽然64-SCTA还不能完全取代CAG,但其无创性、简便性,性价比高且易于接受等优点,适于对CABG术后患者桥血管通畅率进行评价,可以广泛用于患者术后复查。
Objective:Coronary atherosclerotic heart disease is ischemia and hypoxia of heart muscle because of stenosis or occlusion of coronary artery caused by atherosclerosis or(and) functional change(spasm).It is called by a joint name,coronary heart disease,which is also called CHD for short.The main surgical treatment of CHD is coronary artery bypass graft(CABG).CAB G can reconstruct blood supply and improve oxygen supply of ischemia of heart muscle.It also can release symptom of stenocardia and improve function of cardiac muscle and prolong longevity.The main way of rechecking the patient who was operated CABG is conventional coronary angiography(CAG) which is more expensive and more risky and more unacceptable for the most patient.
In recent years,computed tomography coronary angiography is gradually becoming a hot spot in academic study.It display the tree of coronary artery and pathological changes of coronary artery efficiently. 64-slice computed tomography (64-SCT) is especially faster and better in functional software.The diagnostic value of 64-SCTA is bigger because of it’s evaluation of danger-degree and development- tendency of patient who was operated CABG.
Method: From June 2007 to March 2009,choose 27 patients rechecked from out-patient clinic in Tangshan Woker Hospital(17 males and 10 females; age range 49-78 years;mean age: 63.6±7.9years).(after CABG time:from 30-121months , mean time 59±18.7months).All of 27 patients underwent 64-SCTA.10 of them underwent CAG at same time. 5 of them previously underwent procedure of PCI with stent implantation. 1 of them underwent coronary artery bypass surgery (CABG).Others were treated by drugs.According to the suggestion of American Heart Association,the coronary arteries were devided to 9 segment.Bypass grafts were devided to 5-6 segment.The degree of bypass grafts stenosis divided into 4 classes:1, normol ; 2, slight stenosis (﹤50%) ;3, midrange stenosis(50%-75%) ;4, serious stenosis (≥75 % ) .The 64-SCTA’results were analyzed based on the CAG results.The results of the two methods were analyzed by a group of imageologic expert and cardiologists. Considering the blood vessel diameter of two sides of stenosis,Pathological changes and degree of stenosis of coronary artery was evaluated.Two groups do not kown the results of each other. The accuracy and sensitivity and specificity and positive predictive value and negative predictive value of 64-SCTA for diagnosis of stenosis of bypass grafts was evaluated,based on the CAG as a golden standard.Checking difference and consistency between two ways of diagnosis of bypass grafts by Chi-square test and Kappa value.
Results:27 patients were operated 64-SCTA successfully.Each process takes 10～15min.There was no arrhythmia in 27 patients.(heart rate:52～85/min;CTA time: 9.0±1.2s; breath holding time:12～14s)There are Among the 427 coronary arteries segments in 78 bypass grafts,392(91.80%) were evaluated by 64-SCT successfully.(great saphenous vein:52;arterial bridge:23)35(8.20%) were unevaluated (movement shadow: 10 , serious calcification: 12 , metal clips-shadow:13). Evaluable-rate in each kind of bypass grafts: LIMA-LAD(103/115)89.57%, AO-LAD(18/18)100%, AO-RCA(139/150)92.67%, AO-LCX(132/144)91.67%.At the same time,10 of 27 patients were operated CAG.Two kind ways of diagnosis coincidence for 4 stenosis classes were 97.94%,88.24%,92.31%,90.00%. Sensitivity and specificity and accuracy in each groups,stenosis (stenosis≥25%),Up midrange stenosis(stenosis≥50%),Serious stenosis(stenosis≥75%),are 100% 97.94% 98.51% , 100% 100% 100% , 90.00% 100% 99.25%.
In Chi-square test(α=0.05),0.95﹤p﹤0.975,we can not consider two ways of diagnosis of bypass grafts are different.Kappa=0.9350,we can consider there is high consistency between two ways of diagnosis of bypass grafts。
Conclution:In evaluation of normal and stenosis and occlusion of coronary artery and bypass grafts, 64-SCTA takes more accuracy and sensitivity and specificity.It suit to evaluate bypass grafts of patient who was operated CABG because of the good quality of no-traumatic occlusion and convenience and low-price et al,although 64-SCTA can not replace CAG totally.
近年随着CT技术的迅速发展,CT冠状动脉成像(computed tomography coronary angiography,CTA)逐渐成为学术界的研究热点之一,它对通过图像重组可以有效地显示冠状动脉血管树,并准确显示冠状动脉病变。特别是64排螺旋CT(64-slice computed tomography,64-SCT),它对心脏扫描的时间更快,功能软件更完善,对CABG术后患者的危险程度和发展趋势有一定的评估,诊断价值会更大。
方法:选取我院2007年6月～2009年3月门诊复查的CABG术后患者共27例,男17例,女10例,年龄49～78岁,平均(63.6±7.9)岁。搭桥时间至CTA检查时间间隔30～121月,平均(59±18.7)月。所有患者均行64排螺旋CT冠状动脉扫描(64-slice computed tomography coronary angiography,64-SCTA)检查冠状动脉以及冠状动脉术后搭桥血管的病变情况,其中共有10例患者在64-SCTA之后行CAG,5例当时行经皮冠状动脉介入治疗(percutaneous coronary intervention,PCI),1例再次行CABG,其余患者主要以药物治疗为主。参照美国心脏病协会(American Heart Association,AHA)冠状动脉节段划分法,将冠状动脉分为9段,冠状动脉搭桥术治疗后的病人桥血管分为5～6段,血管狭窄依程度分为四级:⑴正常;⑵狭窄程度25～50%为轻度狭窄;⑶狭窄程度50%～75%为中度狭窄;⑷狭窄程度≥75%为重度狭窄。对比分析64-SCTA和CAG的结果。64-SCTA结果由一组影像学专家来分析,以狭窄部位两端的血管直径作为参考值,评价桥血管病变情况,对狭窄程度进行分析及评价。CAG由一组心内科医师报告结果。64-SCTA和CAG两组之间都不知道对方的结果。64-SCTA诊断准确性以CAG结果作为标准,由此计算出敏感性、特异性、阳性预测值、阴性预测值和准确性,并做X2检验比较两种方法的诊断有无差别,计算kappa值查看其一致性。
结果:27例患者均成功接受检查,每位患者大约需要10～15 min完成检查。27例患者均无心律失常,心率为52～85次/分。CTA扫描时间(9.0±1.2)s,屏气时间为12～14s。共发现桥血管78根,其中大隐静脉桥52根,动脉桥23根。共发现427段血管,其中能够满足影像学评价的共392段(占91.80%),35段(占8.20%)无法评价,其中运动伪影10段、严重钙化12段、金属夹伪影13段。LIMA-LAD桥、AO-LAD桥、AO-RCA桥和AO-LCX桥的可评价率分别为(103/115)89.57%、(18/18)100%、(139/150)92.67%、(132/144)91.67%。10例同期行64-SCTA及冠状动脉造影,两者诊断桥血管通畅、轻度狭窄、中度狭窄、重度狭窄的符合率分别为: 97.94%、88.24%、92.31%、90.00%。64-SCTA显示轻度以上狭窄(≥25%)的敏感度和特异度分别为100%和97.94%,准确度为98.51%;64-SCTA显示中度以上狭窄(≥50%)的敏感度和特异度分别为100%和100%,准确度为100%。重度狭窄(≥75%)的敏感度和特异度分别为90.00%和100%,准确度为99.25%。
X2检验,得出0.95
Objective:Coronary atherosclerotic heart disease is ischemia and hypoxia of heart muscle because of stenosis or occlusion of coronary artery caused by atherosclerosis or(and) functional change(spasm).It is called by a joint name,coronary heart disease,which is also called CHD for short.The main surgical treatment of CHD is coronary artery bypass graft(CABG).CAB G can reconstruct blood supply and improve oxygen supply of ischemia of heart muscle.It also can release symptom of stenocardia and improve function of cardiac muscle and prolong longevity.The main way of rechecking the patient who was operated CABG is conventional coronary angiography(CAG) which is more expensive and more risky and more unacceptable for the most patient.
In recent years,computed tomography coronary angiography is gradually becoming a hot spot in academic study.It display the tree of coronary artery and pathological changes of coronary artery efficiently. 64-slice computed tomography (64-SCT) is especially faster and better in functional software.The diagnostic value of 64-SCTA is bigger because of it’s evaluation of danger-degree and development- tendency of patient who was operated CABG.
Method: From June 2007 to March 2009,choose 27 patients rechecked from out-patient clinic in Tangshan Woker Hospital(17 males and 10 females; age range 49-78 years;mean age: 63.6±7.9years).(after CABG time:from 30-121months , mean time 59±18.7months).All of 27 patients underwent 64-SCTA.10 of them underwent CAG at same time. 5 of them previously underwent procedure of PCI with stent implantation. 1 of them underwent coronary artery bypass surgery (CABG).Others were treated by drugs.According to the suggestion of American Heart Association,the coronary arteries were devided to 9 segment.Bypass grafts were devided to 5-6 segment.The degree of bypass grafts stenosis divided into 4 classes:1, normol ; 2, slight stenosis (﹤50%) ;3, midrange stenosis(50%-75%) ;4, serious stenosis (≥75 % ) .The 64-SCTA’results were analyzed based on the CAG results.The results of the two methods were analyzed by a group of imageologic expert and cardiologists. Considering the blood vessel diameter of two sides of stenosis,Pathological changes and degree of stenosis of coronary artery was evaluated.Two groups do not kown the results of each other. The accuracy and sensitivity and specificity and positive predictive value and negative predictive value of 64-SCTA for diagnosis of stenosis of bypass grafts was evaluated,based on the CAG as a golden standard.Checking difference and consistency between two ways of diagnosis of bypass grafts by Chi-square test and Kappa value.
Results:27 patients were operated 64-SCTA successfully.Each process takes 10～15min.There was no arrhythmia in 27 patients.(heart rate:52～85/min;CTA time: 9.0±1.2s; breath holding time:12～14s)There are Among the 427 coronary arteries segments in 78 bypass grafts,392(91.80%) were evaluated by 64-SCT successfully.(great saphenous vein:52;arterial bridge:23)35(8.20%) were unevaluated (movement shadow: 10 , serious calcification: 12 , metal clips-shadow:13). Evaluable-rate in each kind of bypass grafts: LIMA-LAD(103/115)89.57%, AO-LAD(18/18)100%, AO-RCA(139/150)92.67%, AO-LCX(132/144)91.67%.At the same time,10 of 27 patients were operated CAG.Two kind ways of diagnosis coincidence for 4 stenosis classes were 97.94%,88.24%,92.31%,90.00%. Sensitivity and specificity and accuracy in each groups,stenosis (stenosis≥25%),Up midrange stenosis(stenosis≥50%),Serious stenosis(stenosis≥75%),are 100% 97.94% 98.51% , 100% 100% 100% , 90.00% 100% 99.25%.
In Chi-square test(α=0.05),0.95﹤p﹤0.975,we can not consider two ways of diagnosis of bypass grafts are different.Kappa=0.9350,we can consider there is high consistency between two ways of diagnosis of bypass grafts。
Conclution:In evaluation of normal and stenosis and occlusion of coronary artery and bypass grafts, 64-SCTA takes more accuracy and sensitivity and specificity.It suit to evaluate bypass grafts of patient who was operated CABG because of the good quality of no-traumatic occlusion and convenience and low-price et al,although 64-SCTA can not replace CAG totally.
引文
1 Hlatky MA,Rogers WJ,Johnstone I,et al.Medical Care Costs and Quality of Life after Randomization to Coronary Angioplasty or Coronary Bypass Surgery J .N Engl J Med,1997,336 2 :92-99
2 BARI Investigators.Comparison of Coronary Bypass Surgery with Angioplasty in Patients with Multivessel Disease J . N Engl J Med,1996,335 4 :217-225
3 Hamm CW,Reimers J,Ischinger T,et al.A Randomized Study of Coronary Angioplasty Compared with Bypass Surgery in Patientswith Symptomatic Multivessel Coronary Disease J . N Engl J Med,1994,331 16 :1037-1043
4 Fitzgibbon GM, Kafka HP, Leach AJ, et al. Coronary Bypass Graft Fate and Patient Outcome:AngiographicFollow-up of 5065 Grafts Related to Survival and Reoperation in 1388 Patients During 25 Years J .J Am Coll Cardiol,1996,28 3 :616-626
5朱晓东、张宝仁主编,心脏外科学.人民卫生出版社, 2007
6张挽时,徐家兴。冠心病影像诊断学的新进展。中华放射学杂志2000,34 6 : 4284290
7 Janowitz WR. Current status of mechanical computed tomograpy in cardiac imaging .Am J Cardiol, 2001,88 2A :35E-38E
8 FlohrT, StierstorferK,RaupachR, et al.Performance evaluation ofa 64-sliceCT system with z-flying focal spot J .Rofo, 2004, 176: 1803-1810
9 FlohrT,KuttnerA, BruderH, et a.l Performance evaluation of amulti-slice CT system with 16-slice detector and increased gantry rotation speed for isotropic submillimeter imaging of the heart J .Herz, 2003, 28: 7-19
10毛定飚,滑炎卿,张国桢,等.多层螺旋CT冠状动脉造影重建技术的比较J .中国临床医学影象杂志, 2004, 15: 149-151
11 Moon JY, Chung, Choi BW, et al. The utility of multiple-detector row spiral CT for detection of coronary artery stenoses. Yonsei Med J. 2005 Feb 28; 46 1 :86-94
12 Heuschmid M, Kuettner A, Schroeder S, et al. ECG-Gated
16-MDCT of the Coronary Arteries: Assessment of Image Quality and Accuracy in Detecting Stenoses. AJR Am JRoentgenol. 2005 May; 184 5 :1413-9
13 Flohr T, Ktittner A, Bruder H, et al. Performance evaluation of a multi-slice CT system with 16-slice detector and increased gantry rotation speed for isotropic submillimeter imaging of the heart. Herz. 2003 Feb; 28 1 :7-19
14 Moon JY, Chung N, Choi BW, et al. The utility of multiple-detector row spiral CT for detection of coronary artery stenoses. Yonsei Med J. 2005 Feb 28; 46 1 : 86-94
15 Achenbach S, Ropers D, Holle J, et al. In-phase coronary arterial motion velocity: measurement with electron-beam CT. Radiology. 2000 Aug; 216 2 :457-63
16 Flohr T ,Bruder H, Stierstofer K, et al .New technical developments in multislice CT, part 2: sub-millimeter 16-slice scanning and increased gantry rotation speed for cardiac imaging. Rofo. 2002 Aug; 174 8 :1022-7
17 Dejardins B, Kazerooni EA. ECG -gated cadiac CT.AJR 2004; 182:993-1010
18 Hong C, Becker C, Haberl R, et al. ECG-gated reconstructed multi-detector row CT coronary angiography: effect of varying trigger delay on imagine quality. Radiology, 2001,220 3 : 712717
19 Achenbach S, Ulzhemer S, Baum U, et al. Noninvasive coronary angiograp by retrospectively ECG-gated multi-slice spiral CT. Circulation, 2000, 102 23 : 28232828
20 Sanz J, Rius T, Kuschnir P, et al. The importance ofendsystole for optimal reconstruction protocal of coronary angiography with 16-slice multidetector computed tomography.Invest Radiol, 2005, 40 3 : 155163
21 Achenbach S,Moshage W,Ropers D,et al.Noninvasive,three-dimensional visualization of coronary artery bypass grafts by electron beam tomography. Am J Cardiol.1997;79:85861
22 Marano R,Storto ML,Maddestra N,et al.Non-invasive assessment of coronary artery bypass graft with retrospectively ECG-gated four-row multi-detector spiral computed tomography.Eur Radiol.2004:14:1353-1362
23 Burgstahler C,Kuettner A,Kopp AF,et al.Non-invasive evaluation of coronary artery bypass grafts using multi-slice computed tomography:initial clinCAGI experience.Int J Cardiol.2003;90:275-280
24 Gurevitch J,GasPar T,Oriov B,et al.Noninvasive evaluation of arterial grafts with newly released multidetector computed tomography.Ann Thorac Surg.2003;76:1523-1527
25 Nietnan K,Pattynama PM,Rensing BJ,et al.Evaluation of patients after coronary artery bypass surgery:CT angiographic assessment of grafts and coronary arteries.Radiology.2003;229:749-756
26 Mariuseelli E,Romagnoli A,D’Elisco A,et al.Evaluation of venous and arterial conduit patency by 16-slice spiral computed tomography.CircuIation. 2004;110:3234-3238
27 Chiurlia E,Menozzi M,Ratti C,et al.Follow-up of coronary artery byPass graft pateney by multislice computed tomography.Am J Cardiol.2005;95:1094-1097
28 Ropers D,Pohle FK,Kuettner A,et al.Diagnostic Accuracy of Noninvasive Coronary Angiography in Patients Afler Bypass Surgery Using 64-Slice Spiral Computed Tomography With 330-ms Gantry Rotation.Circulation.2006;114:2334-2341
29 Pache G,Saueressig U,Frydrychowiscz A,et al.Initial experience with 64-slice cardiac CT:non- invasive visualization of coronary artery bypass grafts J .Eur Heart J,2006,27 8 :976-980
30 Martuscelli E,Romagnoli A,D’Eliseo D,et al.Evaluation of venous and arterial condit patency by 64-slice spiral computed tomography J .Circulation ,2004,110:3234-3238
31 Kuetter A,Trabold T,Schroeder S,et al.Noninvasive detection of coronary lesions using 16-detector multislice spirl computed tomography technology:initial clinical results J.J Am Coll Cardiol,2004,44:1230-1237
32 Nieman K, Oudker KM, Rensing BJ, et al. Coronary angiography with multislice computed tomography. The Lancet.2001,357 9256 : 599603
33 Dieter R, Stenfan N, Evelyn W, et al. Investigation of aortic coronary artery bypass grafts by multislice spiral computed tomography. Circulation. 2002,106 5 : 637638
34 Hausleiter J,Meyer T,Hadamitzky M,et al.Prevalence of noncalcified coronary plaques by 64-slice computed tomography in patients with an intermediate risk for significant coronary artery disease J .J Am Coll Cardiol,2006,48:321-318
35杜志民,罗初凡,胡承恒,等.稳定型与不稳定型心绞痛患者电子束CT冠状动脉钙化检测的比较J .中山医科大学学报,2001,22 2 :136-140
36 Stary HC, Chandler AS,Dinsmore RE, et al. A definition of advanced types of atherosclerotic lesions and a histological classification of atherosclerosis:a report from the Committee on Vascular Lesions of the Council on Arteriosclerosis,American Heart Association。Circulation, 1995,92: 1355-1374
37 Casscells W,Naghavi M,Willerson JT.Vulnerable atherosclerotic plaque:a multifocal disease.Circulation,2003,107 16 :2072-2075
38 Fayad ZA,Fuster V Clinical imaging of the high-risk or vulnerable atherosclerotic plaque. Circ Res,2001.8 94 :305-316
1卫生部影像设备专家组.2001年北美放射学会第87届年会大型影像学装备的技术进展.中华放射学杂志,2002,36 9 :860
2 Halliburton SS, Stillman AE, Flohr T, et al. Do segmented reconstruction algorithms for cardiac multi-slice computed tomography improve image quality? Herz. 2003 Feb; 28 1 :20-31
3毛定鹰主编,多层螺旋CT冠状动脉成像.北京:科学技术文献出版社,2005
4 Heuschmid M, Kuettner A, Schroeder S,Trabold T, et al. ECG-Gated 16-MDCT of the coronary artery:Assessment of image quality and accuracy in detecting stenoses. AJR Am J Roentgenol. 2005 May; 184 5 :1413-9
5 Cademartiri F, Schuijf JD, et al. Multislice CT coronary angiography: how to do it and what is the current clinical performance Eur J Nucl Med Mol Imaging.2005 Nov 32 11 :1337-47
6 Hoffmann MH, Shi H, Manzke R,et al. Noninvasive coronary angiography with 16-detector row CT:effct of heart rate. Radiology. 2005 Jan;234 1 :86-97
7 Leschka S, Alkadhi H, et al. Accuracy of MSCT coronary angiography with 64-slice technology: first experience. Eur Heart J. 2005 Aug;26 15:1482-7
8 Desjardins B, Kazerooni EA. ECG-gated cadiac CT. AJR Am J Roentgenol. 2004 Apr; 182(4):993-1010
9 Achenbach S,Giesler T,roper D,et al.Detection of coronary artery stenoses by contrast-enhanced,retrospectively electrocardiographically-gated,multislice spiral computed tomograpy.CircuIation,2001,103:2535-2538
10 Giesler T,Baum U,Ropers D,et al.Noninvasive visualization of coronary arteries using contrast-enhanced multidetector CT:influence of heart rate on image quality and stenosis detection.Am J Roentgenol,2002,179:911-916
11 Nieman K,Rensing BJ,van Geuns RJM,et al.Non-invasive coronaryangiography with multislice spiral CT:the impact of heart rate,2002,88:470-474
12 Ohnesorge B,Flohr T,Becker cp,et al.cardiac imaging withECG-gated multi-slice spiral CT initial experience.Radiology,2000,217:564-571
13 Vogl T, Abolmaali ND, Diebold T, et al. Techniquces for the detection of coronary atherosclerosis multi-detector row CT coronary angiography.Radiology. 2002 Apr; 223 1 :212-20
14 Flohr T, Kttttner A, Bruder H, et al. Performance evaluation of a multi-slice CT system with 16-slice detector and increased gantry rotation speed for isotropic submillimeter imaging of the heart. Herz. 2003 Feb;28 1:7-19
15 Flohr T, Bruder H, Stierstorfer K, et al. New technical developments in multislice CT, part 2: sub-millimeter 16-slice scanning and increased gantry rotation speed for cardiac imaging. Rofo. 2002 Aug;174 8 :1022-7
16 Niman K,cademartiri F,Lemos PA,Raaijmakers R,et al.Reliable Noninvasive coronary angiography with fast submillimeter multislice pira computed tomography.Cirejulation.2002,106:2036-2038
17邝平定,张敏鸣,朱建华等。多层螺旋CT回顾性心电门控冠状动脉重建的最佳R-R时相及临床应用。中华放射学杂志。2004,38 2 :178-183
18王昭谦,朱皓,方唯一等。多层螺旋CT显示冠状动脉狭窄的初步研究。医学理论与实践。2004,3:154-157
19肖毅,田建明,王培军等。多层螺旋CT冠状动脉造影的扫描技术及临床应用。中华放射学杂志,2002,36,4 :375-361
20洪澄,Becker CR,朱芳等。冠状动脉狭窄的多层螺旋CT诊断。中华放射学杂志。2002,36:605
21张竹花,金征宇,李冬晶等,冠状动脉多层螺旋CT成像与常规冠脉造影对照研究。临床放射学杂志。2004,23:772-776
22 Marano G. Assessment of coronary arteries with CT J . Radiol Clin North Am,2002,40 7 :773-782
23 Ropers D, Ulzheimer S, Wenkel E, et al. Investigation of aorto-coronary artery bypass grafts by multi slice spiral computed tomography with electrocardiographic-gated image reconstruction J .Am J Cardiol,2001,88 7 :792-795
24 Nieman K, Cademartiri F, Lemos PA, et al. Reliable noninvasive coronary angiography with fast submillimeter multislice spiral computed tomography J . Circulation,2002,106 16 :2051-2054
25 Jiang R, Wu XH, He W. Influence of fluctuation of heart rate on imaging quality of multi-slice spiral CT coronary angiography J .Chin J Med Imaging Technol,2004,20 10 :1574-1576
26 Khot UN,Friedman DT,Pettersson G,et al.Radial artery bypassgrafts have an increased occurrence of angiographically severe stenosis and occlusion compared with left internal mammary arteries and saphenous vein grafts.Circulation,2004,109:2086-2091
27 Shah PJ,Gordon I,Fuller J,et al.Factors affectingsaphenous vein graft patency:clinical and angiographic study in 1402 symptomatic patients operated on between 1977 and 1999.J Thorac Cardiovasc Surg,2003,126:1972-1977
28 Al Ruzzeh S, George S, Bustami M, et al. The early clinical and angiographic outcome of sequential coronary artery bypass grafting the off-pump technique.J Thorae Cardiovasc Surg2002;123:525-530
29 Puskas J,Williams WH,Mahoney EM,et al.Off-pump vs conventional coronary artery bypass grafting:Early and l-year graft patency,cost,and quality-of-life outcomes:a randomized trial.JAMA 2004;291:1841-1849
30 Junjiro K,Tadashi T,Masami O,et al. Early Outcome of a Randomized Comparison of Off-pump and On-Pump Multiple Arterial Coronary Revascularization.Circulation.2005;112 suppll:I-338-I-343
31 Puskas J,Williams W,Duke P,et al.Off-pump coronary artery bypass grafting provides complete revascularization with reduced myocardial injury , transfusion requirements and length of stay: a prospective randomized comparison of two hundred unselected Patients undergoing off-pump versus conventional coronary artery bypass grafting.J Thorae Cardlovasc Surg2003;125:797-808
32 Khan NE,De Souza A,Mister R,Flather M,Clague J,Davies S,et al.A randomized comparison of off-pump and on-pump multivessel coronary artery bypass surgery.N EnglJ Med 2004:350:21-8
33 Lingaas PS,Hol PK,Lundblad R,et al.Clinical and angiographic outcome of coronary surgery with and without cardiopulmonary bypass:A prospective randomized trial.Heart Surg Forum 2004;7:37-41
34 Nathoe H,van Dijk D,Jansen E,Suyker W,Diephuis J,van Boven W,et al. A comparison of on-pump and off-pump coronary bypass surgery in low-risk patients. N Engl J Med 2003;348:394-402
35 Kim K,Lim C,Lee C,et al.Off-pump coronary artery bypass may decrease the pateney of saphenous vein grafts.Ann Thorac Surg 2001:72:51033-7
36 O.Steven G,Karen Z.RN,Thomas M,et al.Long-Term Patency of Saphenous Vein and Left Internal Mammary Artery Grafts After Coronary Artery Bypass Surgery.Results From a Department of Veterans Affairs.Cooperative Study.J Am Coll Cardiol 2004;44:2149-56
37 Gundry S,Romano M,Shatiuck O,Razzouk A, Bailey L.Seven-year follow-up of coronary artery bypass performed with and without cardiopulmonary bypass.J Thorac Cardiovase Surg1998;115:1273-8
38 Angelini G,Taylor F,Reeves B,Aseione R.Early and midterm outcome after off-pump and on-pump surgery in beating heart cardioplegic arrest studies(BHACAS 1and2):a pooled analysis of two randomized controlled trials.Lancet 2002;359:1194-9
2 BARI Investigators.Comparison of Coronary Bypass Surgery with Angioplasty in Patients with Multivessel Disease J . N Engl J Med,1996,335 4 :217-225
3 Hamm CW,Reimers J,Ischinger T,et al.A Randomized Study of Coronary Angioplasty Compared with Bypass Surgery in Patientswith Symptomatic Multivessel Coronary Disease J . N Engl J Med,1994,331 16 :1037-1043
4 Fitzgibbon GM, Kafka HP, Leach AJ, et al. Coronary Bypass Graft Fate and Patient Outcome:AngiographicFollow-up of 5065 Grafts Related to Survival and Reoperation in 1388 Patients During 25 Years J .J Am Coll Cardiol,1996,28 3 :616-626
5朱晓东、张宝仁主编,心脏外科学.人民卫生出版社, 2007
6张挽时,徐家兴。冠心病影像诊断学的新进展。中华放射学杂志2000,34 6 : 4284290
7 Janowitz WR. Current status of mechanical computed tomograpy in cardiac imaging .Am J Cardiol, 2001,88 2A :35E-38E
8 FlohrT, StierstorferK,RaupachR, et al.Performance evaluation ofa 64-sliceCT system with z-flying focal spot J .Rofo, 2004, 176: 1803-1810
9 FlohrT,KuttnerA, BruderH, et a.l Performance evaluation of amulti-slice CT system with 16-slice detector and increased gantry rotation speed for isotropic submillimeter imaging of the heart J .Herz, 2003, 28: 7-19
10毛定飚,滑炎卿,张国桢,等.多层螺旋CT冠状动脉造影重建技术的比较J .中国临床医学影象杂志, 2004, 15: 149-151
11 Moon JY, Chung, Choi BW, et al. The utility of multiple-detector row spiral CT for detection of coronary artery stenoses. Yonsei Med J. 2005 Feb 28; 46 1 :86-94
12 Heuschmid M, Kuettner A, Schroeder S, et al. ECG-Gated
16-MDCT of the Coronary Arteries: Assessment of Image Quality and Accuracy in Detecting Stenoses. AJR Am JRoentgenol. 2005 May; 184 5 :1413-9
13 Flohr T, Ktittner A, Bruder H, et al. Performance evaluation of a multi-slice CT system with 16-slice detector and increased gantry rotation speed for isotropic submillimeter imaging of the heart. Herz. 2003 Feb; 28 1 :7-19
14 Moon JY, Chung N, Choi BW, et al. The utility of multiple-detector row spiral CT for detection of coronary artery stenoses. Yonsei Med J. 2005 Feb 28; 46 1 : 86-94
15 Achenbach S, Ropers D, Holle J, et al. In-phase coronary arterial motion velocity: measurement with electron-beam CT. Radiology. 2000 Aug; 216 2 :457-63
16 Flohr T ,Bruder H, Stierstofer K, et al .New technical developments in multislice CT, part 2: sub-millimeter 16-slice scanning and increased gantry rotation speed for cardiac imaging. Rofo. 2002 Aug; 174 8 :1022-7
17 Dejardins B, Kazerooni EA. ECG -gated cadiac CT.AJR 2004; 182:993-1010
18 Hong C, Becker C, Haberl R, et al. ECG-gated reconstructed multi-detector row CT coronary angiography: effect of varying trigger delay on imagine quality. Radiology, 2001,220 3 : 712717
19 Achenbach S, Ulzhemer S, Baum U, et al. Noninvasive coronary angiograp by retrospectively ECG-gated multi-slice spiral CT. Circulation, 2000, 102 23 : 28232828
20 Sanz J, Rius T, Kuschnir P, et al. The importance ofendsystole for optimal reconstruction protocal of coronary angiography with 16-slice multidetector computed tomography.Invest Radiol, 2005, 40 3 : 155163
21 Achenbach S,Moshage W,Ropers D,et al.Noninvasive,three-dimensional visualization of coronary artery bypass grafts by electron beam tomography. Am J Cardiol.1997;79:85861
22 Marano R,Storto ML,Maddestra N,et al.Non-invasive assessment of coronary artery bypass graft with retrospectively ECG-gated four-row multi-detector spiral computed tomography.Eur Radiol.2004:14:1353-1362
23 Burgstahler C,Kuettner A,Kopp AF,et al.Non-invasive evaluation of coronary artery bypass grafts using multi-slice computed tomography:initial clinCAGI experience.Int J Cardiol.2003;90:275-280
24 Gurevitch J,GasPar T,Oriov B,et al.Noninvasive evaluation of arterial grafts with newly released multidetector computed tomography.Ann Thorac Surg.2003;76:1523-1527
25 Nietnan K,Pattynama PM,Rensing BJ,et al.Evaluation of patients after coronary artery bypass surgery:CT angiographic assessment of grafts and coronary arteries.Radiology.2003;229:749-756
26 Mariuseelli E,Romagnoli A,D’Elisco A,et al.Evaluation of venous and arterial conduit patency by 16-slice spiral computed tomography.CircuIation. 2004;110:3234-3238
27 Chiurlia E,Menozzi M,Ratti C,et al.Follow-up of coronary artery byPass graft pateney by multislice computed tomography.Am J Cardiol.2005;95:1094-1097
28 Ropers D,Pohle FK,Kuettner A,et al.Diagnostic Accuracy of Noninvasive Coronary Angiography in Patients Afler Bypass Surgery Using 64-Slice Spiral Computed Tomography With 330-ms Gantry Rotation.Circulation.2006;114:2334-2341
29 Pache G,Saueressig U,Frydrychowiscz A,et al.Initial experience with 64-slice cardiac CT:non- invasive visualization of coronary artery bypass grafts J .Eur Heart J,2006,27 8 :976-980
30 Martuscelli E,Romagnoli A,D’Eliseo D,et al.Evaluation of venous and arterial condit patency by 64-slice spiral computed tomography J .Circulation ,2004,110:3234-3238
31 Kuetter A,Trabold T,Schroeder S,et al.Noninvasive detection of coronary lesions using 16-detector multislice spirl computed tomography technology:initial clinical results J.J Am Coll Cardiol,2004,44:1230-1237
32 Nieman K, Oudker KM, Rensing BJ, et al. Coronary angiography with multislice computed tomography. The Lancet.2001,357 9256 : 599603
33 Dieter R, Stenfan N, Evelyn W, et al. Investigation of aortic coronary artery bypass grafts by multislice spiral computed tomography. Circulation. 2002,106 5 : 637638
34 Hausleiter J,Meyer T,Hadamitzky M,et al.Prevalence of noncalcified coronary plaques by 64-slice computed tomography in patients with an intermediate risk for significant coronary artery disease J .J Am Coll Cardiol,2006,48:321-318
35杜志民,罗初凡,胡承恒,等.稳定型与不稳定型心绞痛患者电子束CT冠状动脉钙化检测的比较J .中山医科大学学报,2001,22 2 :136-140
36 Stary HC, Chandler AS,Dinsmore RE, et al. A definition of advanced types of atherosclerotic lesions and a histological classification of atherosclerosis:a report from the Committee on Vascular Lesions of the Council on Arteriosclerosis,American Heart Association。Circulation, 1995,92: 1355-1374
37 Casscells W,Naghavi M,Willerson JT.Vulnerable atherosclerotic plaque:a multifocal disease.Circulation,2003,107 16 :2072-2075
38 Fayad ZA,Fuster V Clinical imaging of the high-risk or vulnerable atherosclerotic plaque. Circ Res,2001.8 94 :305-316
1卫生部影像设备专家组.2001年北美放射学会第87届年会大型影像学装备的技术进展.中华放射学杂志,2002,36 9 :860
2 Halliburton SS, Stillman AE, Flohr T, et al. Do segmented reconstruction algorithms for cardiac multi-slice computed tomography improve image quality? Herz. 2003 Feb; 28 1 :20-31
3毛定鹰主编,多层螺旋CT冠状动脉成像.北京:科学技术文献出版社,2005
4 Heuschmid M, Kuettner A, Schroeder S,Trabold T, et al. ECG-Gated 16-MDCT of the coronary artery:Assessment of image quality and accuracy in detecting stenoses. AJR Am J Roentgenol. 2005 May; 184 5 :1413-9
5 Cademartiri F, Schuijf JD, et al. Multislice CT coronary angiography: how to do it and what is the current clinical performance Eur J Nucl Med Mol Imaging.2005 Nov 32 11 :1337-47
6 Hoffmann MH, Shi H, Manzke R,et al. Noninvasive coronary angiography with 16-detector row CT:effct of heart rate. Radiology. 2005 Jan;234 1 :86-97
7 Leschka S, Alkadhi H, et al. Accuracy of MSCT coronary angiography with 64-slice technology: first experience. Eur Heart J. 2005 Aug;26 15:1482-7
8 Desjardins B, Kazerooni EA. ECG-gated cadiac CT. AJR Am J Roentgenol. 2004 Apr; 182(4):993-1010
9 Achenbach S,Giesler T,roper D,et al.Detection of coronary artery stenoses by contrast-enhanced,retrospectively electrocardiographically-gated,multislice spiral computed tomograpy.CircuIation,2001,103:2535-2538
10 Giesler T,Baum U,Ropers D,et al.Noninvasive visualization of coronary arteries using contrast-enhanced multidetector CT:influence of heart rate on image quality and stenosis detection.Am J Roentgenol,2002,179:911-916
11 Nieman K,Rensing BJ,van Geuns RJM,et al.Non-invasive coronaryangiography with multislice spiral CT:the impact of heart rate,2002,88:470-474
12 Ohnesorge B,Flohr T,Becker cp,et al.cardiac imaging withECG-gated multi-slice spiral CT initial experience.Radiology,2000,217:564-571
13 Vogl T, Abolmaali ND, Diebold T, et al. Techniquces for the detection of coronary atherosclerosis multi-detector row CT coronary angiography.Radiology. 2002 Apr; 223 1 :212-20
14 Flohr T, Kttttner A, Bruder H, et al. Performance evaluation of a multi-slice CT system with 16-slice detector and increased gantry rotation speed for isotropic submillimeter imaging of the heart. Herz. 2003 Feb;28 1:7-19
15 Flohr T, Bruder H, Stierstorfer K, et al. New technical developments in multislice CT, part 2: sub-millimeter 16-slice scanning and increased gantry rotation speed for cardiac imaging. Rofo. 2002 Aug;174 8 :1022-7
16 Niman K,cademartiri F,Lemos PA,Raaijmakers R,et al.Reliable Noninvasive coronary angiography with fast submillimeter multislice pira computed tomography.Cirejulation.2002,106:2036-2038
17邝平定,张敏鸣,朱建华等。多层螺旋CT回顾性心电门控冠状动脉重建的最佳R-R时相及临床应用。中华放射学杂志。2004,38 2 :178-183
18王昭谦,朱皓,方唯一等。多层螺旋CT显示冠状动脉狭窄的初步研究。医学理论与实践。2004,3:154-157
19肖毅,田建明,王培军等。多层螺旋CT冠状动脉造影的扫描技术及临床应用。中华放射学杂志,2002,36,4 :375-361
20洪澄,Becker CR,朱芳等。冠状动脉狭窄的多层螺旋CT诊断。中华放射学杂志。2002,36:605
21张竹花,金征宇,李冬晶等,冠状动脉多层螺旋CT成像与常规冠脉造影对照研究。临床放射学杂志。2004,23:772-776
22 Marano G. Assessment of coronary arteries with CT J . Radiol Clin North Am,2002,40 7 :773-782
23 Ropers D, Ulzheimer S, Wenkel E, et al. Investigation of aorto-coronary artery bypass grafts by multi slice spiral computed tomography with electrocardiographic-gated image reconstruction J .Am J Cardiol,2001,88 7 :792-795
24 Nieman K, Cademartiri F, Lemos PA, et al. Reliable noninvasive coronary angiography with fast submillimeter multislice spiral computed tomography J . Circulation,2002,106 16 :2051-2054
25 Jiang R, Wu XH, He W. Influence of fluctuation of heart rate on imaging quality of multi-slice spiral CT coronary angiography J .Chin J Med Imaging Technol,2004,20 10 :1574-1576
26 Khot UN,Friedman DT,Pettersson G,et al.Radial artery bypassgrafts have an increased occurrence of angiographically severe stenosis and occlusion compared with left internal mammary arteries and saphenous vein grafts.Circulation,2004,109:2086-2091
27 Shah PJ,Gordon I,Fuller J,et al.Factors affectingsaphenous vein graft patency:clinical and angiographic study in 1402 symptomatic patients operated on between 1977 and 1999.J Thorac Cardiovasc Surg,2003,126:1972-1977
28 Al Ruzzeh S, George S, Bustami M, et al. The early clinical and angiographic outcome of sequential coronary artery bypass grafting the off-pump technique.J Thorae Cardiovasc Surg2002;123:525-530
29 Puskas J,Williams WH,Mahoney EM,et al.Off-pump vs conventional coronary artery bypass grafting:Early and l-year graft patency,cost,and quality-of-life outcomes:a randomized trial.JAMA 2004;291:1841-1849
30 Junjiro K,Tadashi T,Masami O,et al. Early Outcome of a Randomized Comparison of Off-pump and On-Pump Multiple Arterial Coronary Revascularization.Circulation.2005;112 suppll:I-338-I-343
31 Puskas J,Williams W,Duke P,et al.Off-pump coronary artery bypass grafting provides complete revascularization with reduced myocardial injury , transfusion requirements and length of stay: a prospective randomized comparison of two hundred unselected Patients undergoing off-pump versus conventional coronary artery bypass grafting.J Thorae Cardlovasc Surg2003;125:797-808
32 Khan NE,De Souza A,Mister R,Flather M,Clague J,Davies S,et al.A randomized comparison of off-pump and on-pump multivessel coronary artery bypass surgery.N EnglJ Med 2004:350:21-8
33 Lingaas PS,Hol PK,Lundblad R,et al.Clinical and angiographic outcome of coronary surgery with and without cardiopulmonary bypass:A prospective randomized trial.Heart Surg Forum 2004;7:37-41
34 Nathoe H,van Dijk D,Jansen E,Suyker W,Diephuis J,van Boven W,et al. A comparison of on-pump and off-pump coronary bypass surgery in low-risk patients. N Engl J Med 2003;348:394-402
35 Kim K,Lim C,Lee C,et al.Off-pump coronary artery bypass may decrease the pateney of saphenous vein grafts.Ann Thorac Surg 2001:72:51033-7
36 O.Steven G,Karen Z.RN,Thomas M,et al.Long-Term Patency of Saphenous Vein and Left Internal Mammary Artery Grafts After Coronary Artery Bypass Surgery.Results From a Department of Veterans Affairs.Cooperative Study.J Am Coll Cardiol 2004;44:2149-56
37 Gundry S,Romano M,Shatiuck O,Razzouk A, Bailey L.Seven-year follow-up of coronary artery bypass performed with and without cardiopulmonary bypass.J Thorac Cardiovase Surg1998;115:1273-8
38 Angelini G,Taylor F,Reeves B,Aseione R.Early and midterm outcome after off-pump and on-pump surgery in beating heart cardioplegic arrest studies(BHACAS 1and2):a pooled analysis of two randomized controlled trials.Lancet 2002;359:1194-9