摘要
目的:对比IVUS、QCA,评价MSCT诊断冠心病及判断冠状动脉粥样硬化斑块特征的精确性;并利用MSCT,对比ACS患者的罪犯病变与非罪犯病变及SAP患者的冠状动脉病变的不同,从而评价MSCT识别易损斑块的可行性及其在冠心病患者危险分层中的价值。
方法:
一.MSCT的精确性研究:连续性入选2007年8月-2008年12月期间在我院心内科诊断为冠心病并在1周之内行MSCT、QCA、IVUS检查者,分别利用QCA、IVUS、MSCT三种方法测量同一病变的同一截面的血管截面积、管腔面积、狭窄程度、斑块负荷、重构指数等指标;进而对比QCA、IVUS,评价MSCT诊断冠心病、判断狭窄程度及斑块性质的敏感性、特异性、阴性预测值、阳性预测值等指标。
二.MSCT在冠心病危险分层中的价值研究:连续性入选2007年8月-2009年2月期间在我院心内科诊断为ACS及SAP并于介入治疗前72小时内行MSCT检查者,结合心电图、诊断等临床特征将ACS患者的病变分为罪犯病变、非罪犯病变,将SAP患者的病变定义为稳定病变;根据MSCT,比较ACS患者的罪犯病变与非罪犯病变及SAP患者的冠状动脉病变性质的不同;分析不同临床诊断类型与冠状动脉病变类型之间的关系。
结果:
一.MSCT的精确性研究:
1、MSCT与IVUS对比,显示冠状动脉粥样硬化斑块存在与否的敏感性为98%,特异性为90.1%,PPV为93%,NPV为97%;与CAG对比,显示冠状动脉粥样硬化斑块的敏感性为98%,特异性为92.8%,PPV为95.2%,NPV为97%;
2、MSCT与IVUS对比,显示狭窄程度＞50%病变的敏感性为96.5%,特异性为97.1%,PPV为98.2%,NPV为94.3%;与CAG对比,显示狭窄程度＞50%病变的敏感性为98.2%,特异性为94.4%,PPV为96.58%,NPV为97.1%;
3、MSCT与IVUS测量冠状动脉同一病变同一截面下的V-CSA、L-CSA、BP、RI,各指标之间存在明显直线相关关系;
4、MSCT判断脂质斑块的敏感性为88.9%,特异性为84.9%;纤维斑块的敏感性为73.3%,特异性为91.2%;钙化斑块的敏感性为95.7%,特异性为100%;
5、MSCT提示:脂质斑块、纤维斑块、钙化斑块的CT值分别为45±26Hu、81±29Hu、561±226Hu,三者之间存在明显的统计学差异;
二.MSCT在冠心病危险分层中的价值研究
MSCT图像显示:
1、ACS的罪犯病变与非罪犯病变、SAP患者的病变三组的斑块类型组成存在明显的差异:ACS的罪犯病变,以非钙化病变为主,而另外两组斑块分布特征无明显的差异;三组病变非钙化斑块的组成比例存在统计学差异:ACS患者罪犯病变组,非钙化斑块以脂质斑块为主,而另外两组的非钙化斑块以纤维斑块为主;
2、三组之间的病变狭窄程度、管腔面积无明显的统计学差异,但血管截面积、斑块面积、重构指数、斑块的偏心指数存在明显的统计学差异。进一步分析显示:ACS患者的罪犯病变组存在明显的正性重构、偏心性斑块的比例高于其他组;
3、不同诊断者的冠状动脉病变类型存在明显的统计学差异(P=0.049),STEMI患者的冠状动脉病变以孤立病变居多,而NSTEMI以弥漫性病变居多,而UAP及SAP患者无明显的分布差异。
结论:对比IVUS及QCA,MSCT在诊断冠心病、判断冠状动脉粥样硬化斑块特征方面具有较好的精确性,可作为为无创的影像学方法识别易损斑块,并可对冠心病患者的危险分层提供帮助。
Objective To evaluate the accuracy of multi-slice coronary CT to diagnose coronary disease and the characterization of atherosclerosis plaque,and to test the possibility of using MSCT for recognizing the vulnerable plaque and risk stratification of coronary diseases.
Methods Part one:Patients with known coronary heart diseases underwent MSCT,QCA and IVUS within one week from August of 2007 to December of 2008 were included in this study.V-CSA,L-CSA,stenosis degree and plaque burden of the same section located in the same lesion were tested with three above different methods.Sensitivity,specificity,PPV and NPV of MSCT to diagnose coronary heart diseases and evaluate the characterization of plaque against QCA and IVUS were calcuated.
Part two:Patients diagnosed with acute coronary syndrome(ACS) or stable angina pectoris(SAP) underwent MSCT before percutaneous coronary interventions in 72hours from August of 2007 to February of 2009 were included in this study.Lesions in ACS were divided into culprit and non-culprit ones on the basis of the association of angiographic lesion appearance with ECG and myocardial ischemia as detected during stress testing.Lesions in SAP were classified as stable ones.Further,the characterizations of three different lesions were compared based on MSCT.The relationship between clinical diagnosis and plaque types were also been analyzed.
Results Part one:1.Compared with IVUS,sensitivity,specificity,PPV, and NPV of MSCT for detecting plaque is 98%,90.1%,93%,and 97%, respectively.The corresponding index compared with QCA is 98%,92.8%,95.2%, and 97%,respectively.
2.Compared with IVUS,sensitivity,specificity,PPV,and NPV of MSCT for detecting stenosis degree more than 50%is 96.5%,97.1%,98.2%,and 94.3%, respectively.The corresponding index compared with QCA is 98.2%,94.4%, 96.5%,and 97.1%,respectively.
3.V-CSA,L-CSA,BP and RI tested by MSCT and IVUS in the same section located in the same plaque are rectilinear correlated significantly.
4.Sensitivity,specificity of MSCT for recognizing lipid plaque is 88.9%, 84.9%,respectively.For fibrosis plaque,that is 73.3%,91.2%.For calcified plaque,that is 95.7%,100%.Hounsfield value of lipid,fibrosis and calcified plaque is 45±26Hu,81±29Hu,561±226Hu,respectively.
Part two:1.Plaque characterization of culprit lesions,non-culprit ones,and stable one are statistic difference significantly(P＜0.05).For culprit lesions in ACS, non-calcified plaques are major.But for another two groups,the distribution of three kinds of plaque is no statistic significance.The proportion of non-calcified plaques in three groups is statistically significant.For culprit lesion,lipid plaque is major,but for another two groups,fibrosis plaque is major.
2.The stenosis degree and L-CSA are no statistical significance but V-CSA, PB,RI and EI are statistical significance.Further studies showed:the proportion of positive remolding and eccentric plaque in culprit lesions of ACS are significantly more than another groups.
3.Coronary lesions of different clinical diagnosis are significant difference. For STEMI patients,discrete lesion is major.For NSTEMI patients,diffuse lesion is major.
Conclusions Compared with IVUS and QCA,MSCT is very accurate to diagnose coronary artery diseases,evaluate the characterization of atherosclerosis plaques.It can be as a noninvasive tool to detect vulnerable plaque and stratify coronary risk according to different coronary plaque.
引文
1.Stein PD,Beemath A,Kayali F,.Multidetector computed tomography for the diagnosis of coronary artery disease:a systematic review.Am J Med 2006;119:203-216.
2.Leschka S,Alkadhi H,Plass A,Desbiolles L,et al.Accuracy of MSCT coronary angiography with 64-slice technology:first experience.EurHeart J 2005;26:1482-1487.
3.Raff GL,Gallagher MJ,O'Neill WW,et al.Diagnostic Accuracy of Noninvasive Coronary Angiography Using 64-Slice Spiral Computed Tomography.J Am Coll Cardiol 2005;46:552-557.
4.Patel NA,Stamper DL,Brezinski ME.Review of the ability of optical coherellce tomography to characterize plaque,including a comparison with intravascular ultrasound[J].Cardiovasc Intervent Radiol.2005,28(1):1-9.
5.Anonymous.Evaluation.Multislice computed tomography systems.Health Devices,2002,31(5):161-188.
6.Rydberg J,Buckwalter K A,Caldemeyer K S,et al.Multisection CT:scanning techniques and clinical applications.Radiographics,2000,20(6):1787-1806.
7.Schroeder S,Kopp A F,Baumbach A,et al.Noninvasive detection and evaluation of atherosclerotic coronary plaques with multislice computed tomography.J Am Coll Cardiol,2001,37(5):1430-1435.
8.Kotani J,Mintz G S,Castagna M T,et al.Intravascular ultrasound analysis of infarct-related and non-infarct-related arteries in patients who presented with an acute myocardial infarction.Circulation,2003,107(23):2889-2893.
9.Hong M K,Mintz G S,Lee C W,et al.The site of plaque rupture in native coronary arteries:a three-vessel intravascular ultrasound analysis.[J].J Am Coll Cardiol,2005,46(2):261-265.
10.Hodgson J M,Reddy K G,Suneja R,et al.Intracoronary ultrasound imaging: correlation of plaque morphology with angiography,clinical syndrome and procedural results in patients undergoing coronary angioplasty.J Am Coll Cardiol,1993,21(1):35-44.
11.Caussin C,Larchez C,Ghostine S,et al.Comparison of Coronary Minimal Lumen Area Quantification by Sixty-Four-Slice Computed Tomography Versus Intravascular Ultrasound for Intermediate Stenosis.The American Journal of Cardiology,2006,98(7):871-876.
12.Leber A W,Knez A,Von Z F,et al.Quantification of Obstructive and Nonobstructive Coronary Lesions by 64-Slice Computed Tomography:A Comparative Study With Quantitative Coronary Angiography and Intravascular Ultrasound.Journal of the American College Cardiology,2005,46(1):147-154.
13.Thorsten R.C.Johnson,Konstantin Nikolaou,Stephanie Busch.Diagnostic accuracy of dual-source computed tomography in the diagnosis of coronary artery disease.Investigative Radiology 2007;42:694-691
14.Pundziute,Gabija,Schuijf,et al.Evaluation of plaque characteristics in acute coronary syndromes:non-invasive assessment with multi-slice computed tomography and invasive evaluation with intravascular ultrasound radiofrequency data analysis.European Heart Journal 2008;29:2373-2381.
15.Hammer-Hansen S,Kofoed KF,Kelbaek H.Volumetric evaluation of coronary plaque in patients presenting with acute myocardial infarction or stable angina pectoris-a multislice computerized tomography study.Am Heart J.2009,157(3):481-7.
1.Leber AW,Knez A,von Ziegler F,et al.Quantification of obstructive and non-obstructive coronary lesions by 64-slice computed tomography:a comparative study with quantitative coronary angiography and intravascular ultrasound.J Am Coll Cardiol 2005;46:147-154.
2.Leschka S,Alkadhi H,Plass A,et al.Accuracy of MSCT coronary angiography with 64-slice technology:first experience.EurHeart J 2005;26:1482-1487.
3.Raff GL,Gallagher MJ,O'Neill WW,et al.Diagnostic Accuracy of Noninvasive Coronary Angiography Using 64-Slice Spiral Computed Tomography.J Am Coll Cardiol 2005;46:552-557.
4.Stein PD,Beemath A,Kayali F,et al.Multidetector computed tomography for the diagnosis of coronary artery disease:a systematic review.Am J Med 2006;119:203-216.
5.Wang MH,Sun AJ,Qian JY,et al.Myocardial bridging detection by non-invasive multislice spiral computed tomography:comparison with intravascular ultrasound.Chin Med J(Engl) 2008;121:17-21.
6.Caussin C,Larchez C,Ghostine S.Comparison of coronary minimal lumen area quantification by sixty-four-slice computed tomography versus intravascular ultrasound for intermediate stenosis.J Am Coll Cardiol 2006;98:871-876
7.Sun J,Zhang Z,Lu B,et al.Identification and quantification of coronary atherosclerotic plaques:a comparison of 64-MSCT and intravascular ultrasound.AJR Am Reentqenol 2008;190:748-54.
8.Kotani J,Mintz GS,Castagna MT.Intravascular ultrasound analysis of infarct-related and non-infarct-related arteries in patients who presented with an acute myocardial infarction.Circulation.2003 Jun 17;107(23):2889-93.
9.Mei jboom WB,Van Mieqhem CA,Mollet NR.64-Slice Computed Tomography Coronary Angiography in Patients with High,Intermediate,or Low Pretest Probability of Significant Coronary Artery Disease.J Am Coll Cardiol 2007;50:1469-1475.
10.Pundziute,Gabija,Schuijf,et al.Evaluation of plaque characteristics in acute coronary syndromes:non-invasive assessment with multi-slice computed tomography and invasive evaluation with intravascular ultrasound radiofrequency data analysis.European Heart Journal 2008;29:2373-2381.
11.Kitagawa T,Yamamoto H,Ohhashi N,et al.Comprehensive evaluation of noncalcified coronary plaque characteristics detected using 64-slice computed tomography in patients with proven or suspected coronary artery disease.Am Heart J 2007;154:1191-8.
12.Li XM,Huang CX,Wang TS,et al.Comparison of coronary plaque composition among patients with acute coronary syndrome and stable coronary artery disease.Chin Med J(Engl) 2008;121:534-539.
13.黄美萍,刘其顺,刘辉等。多层螺旋CT冠状动脉成像质量及其对冠状动脉病变诊断准确性的评价。中华放射学杂志,2006,40:984-987.
14.王照谦,朱皓,周旭臣等。多层螺旋CT诊断冠状动脉狭窄的价值和限度。中华心血管病杂志,2008,36:989-993
15.James K.Min,Leslee J.Shaw,Richard B,et al.Prognostic value of multidetector coronary computed tomographic angiography for prediction of all cause mortality.Journal of American College of Cardiology 2007;50:1161-1170.
16.叶红华,金田秀昭,齐藤滋等。64层CT与血管内超声对冠状动脉粥样斑块的定性和定量评估的对照研究。中华心血管病杂志,2007;35:648-51。
17.Sadako Motoyama,Takeshi Kondo,Masayoshi Sarai.Multislice Computed Tomographic characteristics of coronary lesions in acute coronary syndromes.Journal of American College of Cardiology 2007;50:319-326
18.Hamon M,Biondi-Zoccai GG,Malagutti P,et al.Diagnostic performance of multislice spiral computed tomography of coronary arteries as compared with conventional invasive coronary angiography:a meta-analysis.J Am Coll Cardiol 2006;48:1896-910.
19.Thorsten R.C.Johnson,Konstantin Nikolaou,Stephanie Busch.Diagnostic accuracy of dual-source computed tomography in the diagnosis of coronary artery disease.Investigative Radiology 2007;42:694-691
20.Moselewski F,Ropers D,Pohle K,et al.Comparison of measurement of cross-sectional coronary atherosclerotic plaque and vessel areas by 16-slice multidetector computed tomography versus intravascular ultrasound.The American Journal of cardiology,2004,94(10):1294-1297.
21.Alexander W.Leber,Thorsten Johnson,Alexander Becker.Diagnostic accuracy of dual-source multi-slice CT coronary angiography in patients with intermediate pretest likelihood for coronary artery disease.European Heart Journal 2007;28:2354-2360.
22.Brodoefel H,MD,Heuschmid M,Tsiflikas 1,et al.Accuracy of dual-source computed tomography in the assessment of plaque morphology:use of quantitative analysis software in comparison to IVUS virtual histology.Eur Radiol,2008,20(50):1110-1118.
23.Pohle K,Achenbach S,Macneill B,et al.Characterization of non-calcified coronary atherosclerotic plaque by multi-detector row CT:comparison to IVUS.Atherosclerosis,2007,190(1):174-180.
24.Schuijf JD,Shaw LJ,Wijns W,Lamb HJ,et al.Cardiac imaging in coronary artery disease:differing modalities.Heart 2005;91:1110-7.
25.Cervinka P,De Feyter PJ,Costa M.Intravascular ultrasound in cardiology.Vnitr Lek.2000,Aug;46(8):470-5.
26.Martuscelli E,Romagnoli AD,Eliseo A,et al.Accuracy of thin-slice computed tomography in the detection of coronary stenoses.Eur Heart J,2004,25:1043.
27.Anonymous.Evaluation.Multislice computed tomography systems.Health Devices.2002,31(5):161-188.
28.Rydberg J,Buckwalter K A,Caldemeyer K S,et al.Multi-slice CT:scanning techniques and clinical applications.Radiographics,2000,20(6):1787-1806.
29.Schroeder S,Kopp A F,Baumbach A,et al.Noninvasive detection and evaluation of atherosclerotic coronary plaques with multislice computed tomography.J Am Coll Cardiol,2001,37(5):1430-1435.
30.Kotani J,Mintz G S,Castagna M T,et al.Intravascular ultrasound analysis of infarct-related and non-infarct-related arteries in patients who presented with an acute myocardial infarction.Circulation,2003,107(23):2889-2893.
31.Hong M K,Mintz G S,Lee C W,et al.The site of plaque rupture in native coronary arteries:a three-vessel intravascular ultrasound analysis.J Am Coll Cardiol,2005,46(2):261-265.
32.Vogl T J,Abolmaali N D,Diebold T,et al.Techniques for the detection of coronary atherosclerosis:multi-detector row CT coronary angiography.Radiology,2002,223(1):212-220.
33.Herzog C,Ay M,Engelmann K,et al.Visualization techniques in multislice CT-coronary angiography of the heart.Correlations of axial,multiplanar,three-dimensional and virtual endoscopic imaging with the invasive diagnosis.Rofo,2001,173(4):341-349.
34.Carrascosa P M,Capunay C M,Garcia-merletti P,et al.Characterization of Coronary Atherosclerotic Plaques by Multidetector Computed Tomography.The American Journal of ardiology,2006,97(5):598-602.
35.Moses J W,Stone G W,Nikolsky E,et al.Drug-eluting stents in the treatment of intermediate lesions:pooled analysis from four randomized trials.J Am Coll Cardiol,2006,47(11):2164-2171.
36.Nikolaou K,Knez A,Rist C,et al.Accuracy of 64-MSCT in the diagnosis of ischemic heart disease.AJR Am J Roentgenol,2006,187(1):111-117.
37.Kitagawa T,Yamamoto H,Ohhashi N,et al.Comprehensive evaluation of noncalcified coronary plaque characteristics detected using 64-slice computed tomography in patients with proven or suspected coronary artery disease.Am Heart J,2007,154(6):1191-1198.
38.Achenbach S,Ropers D,Hoffmann U,et al.assessment of coronary remodeling in stenotic and nonstenotic coronary atherosclerotic lesions by multidetector spiral computed tomography.Journal of the American College of Cardiology,2004,43(5):842-847.
39.Thorsten Johnson,Konstantin Nikolaou,Stephanie Busch.Diagnostic accuracy of dual-source computed tomography in the diagnosis of coronary artery disease.Investigative Radiology,2007,42(10):684-691.
1.Maehara A,Mintz GS,Bui AB,et al.Morphologic and angiographic features of coronary plaque rupture detected by intravascular ultrasound.J Am Coll Cardiol 2002;40:904-10.
2.Burke AP,Farb A,Malcom GT,Liang YH,Smialek J,Virmani R.Coronary risk factors and plaque morphology in men with coronary disease who died suddenly.N Engl J Med 1997;336:1276-82.
3.Maehara A,Mintz GS,Bui AB,et al.Morphologic and angiographic features of coronary plaque rupture detected by intravascular ultrasound.J Am Coll Cardiol 2002;40:904-10.
4.Virmani R,Burke AP,Farb A,et al.Pathology of the unstable plaque.Prog Cardiovasc Dis 2002;44:349-56.
5.Schoenhagen P,Ziada KM,Kapadia SR,et al.Extent and direction of arterial remodeling in stable versus unstable coronary syndromes:an intravascular ultrasound study.Circulation 2000;101:598-603.
6.Hassani S-E,Mintz GS,Fong HS,et al.Negative remodeling and calcified plaque in octogenarians with acute myocardial infarction:an intravascular ultrasound analysis.J Am Coll Cardiol 2006;47:2413-9.
7.Naghavi M,Libby P,Falk E,et al.From vulnerable plaque tovulnerable patient:a call for new definitions and risk assessmentstrategies:part Ⅱ.Circulation 2003;108:1772-8.
8.Schaar JA,Muller JE,Falk E,et al.Terminology for high-risk and vulnerable coronary artery plaques.Report of a meeting on the vulnerable plaque,June 17 and 18,2003,Santorini,Greece.Eur Heart J 2004;25:1077-82.
9.Narula J,Willerson JT.Prologue:detection of vulnerable plaque.J Am Coll Cardiol 2006;47:1.
10.Muller JE,Tawakol A,Kathiresan S,et al.New opportunities for identification and reduction of coronary risk:treatment of vulnerable patients,arteries,and plaques.J Am Coll Cardiol 2006;47:2-6.
11.Sano K,Kawasaki M,Ishihara Y,et al.Assessment of vulnerable plaques causing acute coronary syndrome using integrated backscatter intravascular ultrasound.J Am Coll Cardiol 2006;47:734-41.
12.Jang IK,Tearney GJ,MacNeill B,et al.In vivo characterization of coronary atherosclerotic plaque by use of optical coherence tomography.Circulation 2005;111:1551-5.
13.Schneiderman J,Wilensky RL,Weiss A,et al.Diagnosis of thin-cap fibroatheromas by a self-contained intravascular magnetic resonance imaging probe in ex vivo human aortas and in situ coronary arteries.J Am Coll Cardiol 2005;45:1961-9.
14.Wilensky RL,Song HK,Ferrari VA.Role of magnetic resonance and intravascular magnetic resonance in the detection of vulnerable plaques.J Am Coll Cardiol 2006;47:48-56.
15.Toutouzas K,Drakopoulou M,Mitropoulos J,et al.Elevated plaque temperature in non-culprit de novo atheromatous lesions of patients with acute coronary syndromes.J Am Coll Cardiol 2006;47:301-6.
16.Madjid M,Willerson JT,Casscells SW.Intracoronary thermography for detection of high-risk vulnerable plaques.J Am Coll Cardiol 2006;47:80-5.
17.Hoffmann MH,Shi H,Schmitz BL,et al.Noninvasive coronary angiography with multislice computed tomography.JAMA 2005;293:2471-8.
18.Raff GL,Gallagher MJ,O'Neill WW,et al.Diagnostic accuracy of noninvasive coronary angiography using 64-slice spiral computed tomography.J Am Coll Cardiol 2005;46:552-7.
19.Cordeiro MAS,Lima JAC.Atherosclerotic plaque characterization by multidetector row computed tomography angiography.J Am Coll Cardiol 2006;47:40-7.
20.James S.Chen.Noninvasive coronary plaque evaluation by cardiac CT.Applied Radiology 2007;1:58-60
21.Pundziute,Gabija,Schuijf,et al.Evaluation of plaque characteristics in acute coronary syndromes:non-invasive assessment with multi-slice computed tomography and invasive evaluation with intravascular ultrasound radiofrequency data analysis.European Heart Journal 2008;29:2373-81.
22.Varnava AM,Mills PG,Davies MJ.Relationship between coronary artery remodeling and plaque vulnerability.Circulation 2002;105:939-43.
23.Virmani R,Burke AP,Farb A,et al.Pathology of the vulnerable plaque.J Am Coll Cardiol 2006;47:13-8.
24.Schroeder S,Kopp AF,Baumbach A,et al.Noninvasive detection and evaluation of atherosclerotic coronary plaques with multislice computed tomography.J Am Coll Cardiol 2001;37:1430-5.
25.Kolodgie FD,Virmani R,Burke AP,et al.Pathologic assessment of the vulnerable human coronary plaque.Heart 2004;90:1385-91.
26.Motoyama S,Kondo T,Anno H,et al.Atherosclerotic plaque characterization by 0.5-mm-slice multislice computed tomographic imaging.Circ J 2007;71:363-6.
27.Hoffmann U,Moselewski F,Nieman K,et al.Noninvasive assessment of plaque morphology and composition in culprit and stable lesions in acute coronary syndrome and stable lesions in stable angina by multidetector computed tomography.J Am Coll Cardiol 2006;47:1655-62.
28.Hoffmann U,Moselewski F,Cury RC,et al.Predictive value of 16-slice multidetector spiral computed tomography to detect significant obstructive coronary artery disease in patients at high risk for coronary artery disease:patient-versus segment-based analysis.Circulation 2004;110:2638-43.
29.Hammer-Hansen S,Kofoed KF,Kelbaek H.Volumetric evaluation of coronary plaque in patients presenting with acute myocardial infarction or stable angina pectoris-a multislice computerized tomography study.Am Heart J.2009,157(3):481-7.
30.Mario Petrettaa,Pierluigi Costanzob,Wanda Acampac,et al.Noninvasive assessment of coronary anatomy and myocardial perfusion:going toward an integrated imaging approach.J Cardiovasc Med 2008;9:977-986
31.Nieman K,Cademartiri F,Lemos PA,et al.Reliable noninvasive coronary angiography with fast submillimeter multislice spiral computed tomography.Circulation 2002;106:2051-4.
32.Achenbach S,Moselewski F,Ropers D,et al.Detection of calcified and noncalcified coronary atherosclerotic plaque by contrast-enhanced,submillimeter multidetector spiral computed tomography:a segment based comparison with intravascular ultrasound.Circulation 2004;109:14-7.
33.Achenbach S,Ropers D,Hoffmann U,et al.Assessment of coronary remodeling in stenotic and nonstenotic coronary atherosclerotic lesions by multidetector spiral computed tomography.J Am Coll Cardiol 2004;43:842-7.
34.Ferencik M,Moselewski F,Ropers D,et al.Quantitative parameters of image quality in multidetector spiral computed tomographic coronary imaging with submillimeter collimation.Am J Cardiol 2003;92:1257-62.
35.Abedin M,Tintut Y,Demer LL.Vascular calcification:mechanisms and clinical ramifications.Arterioscler Thromb Vasc Biol 2004;24:1161-70.
36.Ehara S,Kobayashi Y,Yoshiyama M,et al.Spotty calcification typifies the culprit plaque in patients with acute myocardial infarction:an intravascular ultrasound study.Circulation 2004;110:3424-9.
37.Nakamura M,Nishikawa H,Mukai S,et al.Impact of coronary artery remodeling on clinical presentation of coronary artery disease:an intravascular ultrasound study.J Am Coll Cardiol 2001;37:63-9.
38.Naghavi M,Libby P,Falk E,et al.From vulnerable plaque to vulnerable patient:a call for new definitions and risk assessment strategies:part Ⅰ.Circulation 2003;108:1664-72.
39.Ropers D,Baum U,Pohle K,et al.Detection of coronary artery stenoses with thin-slice multi-detector row spiral computed tomography and multiplanar reconstruction.Circulation 2003;107:664-6.
40.Leber AW,Knez A,von Ziegler F,et al.Quantification of obstructive and nonobstructive coronary lesions by 64-slice computed tomography:a comparative study with quantitative coronary angiography and intravascular ultrasound.J Am Coll Cardiol 2005;46:154.
41.Leschka S,Alkadhi H,Plass A,et al.Accuracy of MSCT coronary angiography with 64-slice technology:first experience.Eur Heart J 2005;26:1482-7.
42.Goldstein JA,Demetriou D,Grines CL,Pica M,Shoukfeh M,O'Neill WW.Multiple complex coronary plaques in patients with acute myocardial infarction.N Engl J Med 2000;343:915-22.
43.Kotani J,Mintz GS,Castagna MT,et al.Intravascular ultrasound analysis of infarct-related and non-infarct-related arteries in patients who presented with an acute myocardial infarction.Circulation 2003;107:2889-93.
44.Yamagishi M,Terashima M,Awano K,et al.Morphology of vulnerable coronary plaque:insights from follow-up of patients examined by intravascular ultrasound before an acute coronary syndrome.J Am Coll Cardiol 2000;35:106-11.
45.Fujii K,Kobayashi Y,Mintz GS,et al.Intravascular ultrasound assessment of ulcerated ruptured plaques:a comparison of culprit and nonculprit lesions of patients with acute coronary syndromes and lesions in patients without acute coronary syndromes.Circulation 2003;108:2473-8.
46.James K.Min,Leslee J,Shaw,Richard B,Deverux.Prognostic value of multidetector coronary computed tomographic angiography for prediction of all-cause mortility.J AM Coll 2007;50:1161-70.
47.Burke AP,Kolodgie FD,Farb A,et al.Healed plaque ruptures and sudden coronary death:evidence that subclinical rupture has a role in plaque progression.Circulation 2001;103:934-40.
48.Raggi P,Callister TQ,Cooil B,et al.Evaluation of chest pain in patients with low to intermediate pretest probability of coronary artery disease by electron beam computed tomography.Am J Cardiol 2000;85:283-8.
49.Budoff MJ,Diamond GA,Raggi P,et al.Continuous probabilistic prediction of angiographically significant coronary artery disease using electron beam tomography.Circulation 2002;105:1791-6.
1.Leschka S,Alkadhi H,Plass A,Desbiolles L,et al.Accuracy of MSCT coronary angiography with 64-slice technology:first experience.EurHeart J 2005;26:1482-1487.
2.Raff GL,Gallagher MJ,O'Neill WW,Goldstein JA.Diagnostic Accuracy of Noninvasive Coronary Angiography Using 64-Slice Spiral Computed Tomography.J Am Coll Cardiol 2005;46:552-557.
3.Stein PD,Beemath A,Kayali F,et al.Multidetector computed tomography for the diagnosis of coronary artery disease:a systematic review.Am J Med 2006;119:203-216.
4.Patel NA,Stamper DL,Brezinski ME.Review of the ability of optical coherellce tomography to characterize plaque,including a comparison with intravascular ultrasound[J].Cardiovasc Intervent Radiol.2005,28(1):1-9.
5.Wang MH,Sun AJ,Qian JY,Ling QZ,et al.Myocardial bridging detection by non-invasive multislice spiral computed tomography:comparison with intravascular ultrasound.Chin Med J(Engl) 2008;121:17-21.
6.Leber AW,Knez A,von Ziegler F,et al.Quantification of obstructive and non-obstructive coronary lesions by 64-slice computed tomography:a comparative study with quantitative coronary angiography and intravascular ultrasound.J Am Coll Cardiol 2005;46:147-154.
7.Caussin C,Larchez C,Ghostine S.Comparison of coronary minimal lumen area quantification by sixty-four-slice computed tomography versus intravascular ultrasound for intermediate stenosis.J Am Coll Cardiol 2006;98:871-876
8.Sun J,Zhang Z,Lu B,et al.Identification and quantification of coronary atherosclerotic plaques:a comparison of 64-MSCT and intravascular ultrasound.AJR Am Reentqenol 2008;190:748-54.
9.Meng L,Lv B,Zhang S,et al.In vivo optical coherence tomography of experimental thrombosis in rabbit carotid model.Heart,2008,94:777-780.
10.黄美萍,刘其顺,刘辉等。多层螺旋CT冠状动脉成像质量及其对冠状动脉病变诊断准确性的评价。中华放射学杂志,2006,40:984-987.
11.王照谦,朱皓,周旭臣等。多层螺旋CT诊断冠状动脉狭窄的价值和限度。中华心血管病杂志,2008,36:989-993
12.Kotani J,Mintz GS,Castagna MT.Intravascular ultrasound analysis of infarct-related and non-infarct-related arteries in patients who presented with an acute myocardial infarction.Circulation.2003 Jun 17;107(23):2889-93.
13.侯静波,孟令波,景慎鸿等。光学相干断层成像和血管内超声在冠状动 脉介入手术中的应用。中华心血管病杂志,2008,36:980-984。
14.Mei jboom WB,Van Mieqhem CA,Mollet NR.64-Slice Computed Tomography Coronary Angiography in Patients with High,Intermediate,or Low Pretest Probability of Significant Coronary Artery Disease.J Am Coll Cardiol 2007;50:1469-1475.
15.Kitagawa T,Yamamoto H,Ohhashi N,et al.Comprehensive evaluation of noncalcified coronary plaque characteristics detected using 64-slice computed tomography in patients with proven or suspected coronary artery disease.Am Heart J 2007;154:1191-8.
16.Li XM,Huang CX,Wang TS,et al.Comparison of coronary plaque composition among patients with acute coronary syndrome and stable coronary artery disease.Chin Med J(Engl) 2008;121:534-539.
17.Alexander W.Leber,Thorsten Johnson,Alexander Becker.Diagnostic accuracy of dual-source multi-slice CT coronary angiography in patients with intermediate pretest likelihood for coronary artery disease.European Heart Journal 2007;28:2354-2360.
18.James K.Min,Leslee J.Shaw,Richard B,Devereux.Prognostic value of multidetector coronary computed tomographic angiography for prediction of all cause mortality.Journal of American College of Cardiology 2007;50:1161-1170.
19.叶红华,金田秀昭,齐藤滋等。64层CT与血管内超声对冠状动脉粥样斑块的定性和定量评估的对照研究。中华心血管病杂志,2007;35:648-51。
20.Hammer-Hansen S,Kofoed KF,Kelbaek H.Volumetric evaluation of coronary plaque in patients presenting with acute myocardial infarction or stable angina pectoris-a multislice computerized tomography study.Am Heart J.2009,157(3):481-7.
21.Jang JK,Tearney GJ,MacNeill B,et al.In vivo characterization of coronary atherosclerotic plaque by use of optical coherence tomography.Cieculation,2005,111:1551-1555.
22.Sadako Motoyama,Takeshi Kondo,Masayoshi Sarai.Multislice Computed Tomographic characteristics of coronary lesions in acute coronary syndromes.Journal of American College of Cardiology 2007;50:319-326
23.Hamon M,Biondi-Zoccai GG,Malagutti P,et al.Diagnostic performance of multislice spiral computed tomography of coronary arteries as compared with conventional invasive coronary angiography:a meta-analysis.J Am Coll Cardiol 2006;48:1896-910.
24.盖鲁粤,李萍,金琴花。CT引导的慢性闭塞病变的介入治疗。中华老年心血管病杂志2008,10;331-333.
25.Pundziute,Gabija,Schuijf,et al.Evaluation of plaque characteristics in acute coronary syndromes:non-invasive assessment with multi-slice computed tomography and invasive evaluation with intravascular ultrasound radiofrequency data analysis.European Heart Journal 2008;29:2373-2381.
26.Chen BX,Ma FY,Luo W,et al.Neointimal coverage of barametal and sirolimus-eluting stents evaluated with optical coherence tomography.Heart,2008,94:566-570.
27.Bouma BE,Tearney GJ,Yabushita H,et al.Evalution of intracoronary stenting by intravascular optical coherence tomography.Heart,2003,89:317-320.
28.Thorsten R.C.Johnson,Konstantin Nikolaou,Stephanie Busch.Diagnostic accuracy of dual-source computed tomography in the diagnosis of coronary artery disease.Investigative Radiology 2007;42:694-691
29.Schuijf JD,Shaw LJ,Wijns W,et al.Cardiac imaging in coronary artery disease:differing modalities.Heart 2005;91:1110-7.
30.Cervinka P,De Feyter PJ,Costa M.Intravascular ultrasound in cardiology.Vnitr Lek.2000,46(8):470-5
31.韩志刚,于波,侯静波等。光学相干断层成像评价经皮冠状动脉内支架术后即刻效果。中华心血管病杂志,2006,34:625-626。
1.Virmani R,Kolodgie FD,Burke AP,et al.Lessons from sudden coronary death:a comprehensive morphological classification scheme for atherosclerotic lesions.Arterioscler Thromb Vasc Biol 2000;20:1262-1275.
2.Naghavi M,Libby P,Falk E,et al.From vulnerable plaque to vulnerable patient:a call for new definitions and risk assessment strategies:part I.Circulation 2003;108:1664-1672.
3.Kooi ME,Cappendijk VC,Cleutjens KB,et al.Accumulation of ultrasmall superparamagnetic particles of iron oxide in human atherosclerotic plaques can be detected by in vivo magnetic resonance imaging.Circulation 2003;107:2453-2458.
4.Kim WY,Danias PG,Stuber M,et al.Coronary magnetic resonance angiography for the detection of coronary stenoses.N Engl J Med 2001;345:1863-1869.
5.Hatsukami TS,Ross R,Polissar NL,et al Visualization of fibrous cap thickness and rupture in human atherosclerotic carotid plaque in vivo with high-resolution magnetic resonance imaging.Circulation 2000;102:959-964.
6.Fayad ZA,Fuster V,Fallon JT,et al.Noninvasive in vivo human coronary artery lumen and wall imaging using black-blood magnetic resonance imaging.Circulation 2000;102:506-510.
7.Botnar RM,Stuber M,Kissinger KV.Noninvasive coronary vessel wall and plaque imaging with magnetic resonance imaging.Circulation 2000;102:2582-2587.
8.Berg A,Sailer J,Rand T.Diffusivity-and T2 imaging at 3 Tesla for the detection of degenerative changes in human-excised tissue with high resolution:atherosclerotic arteries.Invest Radiol 2003;38:452-459.
9.Botnar RM,Perez AS,Witte S,et al.In vivo molecular imaging of acute and subacute thrombosis using a fibrinbinding magnetic resonance imaging contrast agent.Circulation 2004;109:2023-2029.
10.Dirksen MS,Lamb HJ,Kunz P.Improved MR coronary angiography with use of a new rapid clearance blood pool contrast agent in pigs.Radiology 2003;227:802-808.
11.Schneiderman J,Wilensky RL,Weiss A,et al.Diagnosis of thin-cap fibroatheromas by a selfcontained intravascular magnetic resonance imaging probe in ex vivo human aortas and in situ coronary arteries.J Am Coll Cardiol 2005;45:1961-1969.
12.Cademartiri F,Nieman K,van der Lugt A,et al.Intravenous contrast material administration at 16-detector row helical CT coronary angiography:test bolus versus bolustracking technique.Radiology 2004;233:817-823.
13.Cademartiri F,Mollet NR,Runza G,et al.Reduction of motion artefacts from mild heart rhythm irregularities with ECG-editing using multislice computed tomography coronary angiography.AJR Am J Roentgenol 2006;186:634-648.
14.Achenbach S,Giesler T,Ropers D,et al.Detection of coronary artery stenoses by contrast-enhanced,retrospectively electrocardiographically gated,multislice spiral computed tomography.Circulation 2001;103:2535-2538.
15.Ropers D,Baum U,Pohle K,et al.Detection of coronary artery stenoses with thin-slice multi-detector row spiral computed tomography and multiplanar reconstruction.Circulation 2003;107:664-666.
16.Martuscelli E,Romagnoli A,D'Eliseo A,et al.Accuracy of thin-slice computed tomography in the detection of coronary stenoses.Eur Heart J 2004;25:1043-1048.
17.Mollet NR,Cademartiri F,Nieman K,et al.Multislice spiral computed tomography coronary angiography in patients with stable angina pectoris.J Am Coll Cardiol 2004;43:2265-2270.
18.Hoffmann U,Moselewski F,Cury RC,et al.Predictive value of 16-slice multidetector spiral computed tomography to detect significant obstructive coronary artery disease in patients at high risk for coronary artery disease:patient-versus segment-based analysis.Circulation 2004;110:2638-2643.
19.Kuettner A,Beck T,Drosch T,et al.Diagnostic accuracy of noninvasive coronary imaging using 16-detector slice spiral computed tomography with 188 ms temporal resolution.J Am Coll Cardiol 2005;45:123-127.
20.Mollet NR,Cademartiri F,Krestin GP,et al.Improved diagnostic accuracy with 16-row multi-slice computed tomography coronary angiography.J Am Coll Cardiol 2005;45:128-132.
21.Hoffmann MH,Shi H,Schmitz BL,et al.Noninvasive coronary angiography with multislice computed tomography.JAMA 2005;293:2471-2478.
22.Leschka S,Alkadhi H,Plass A,et al.Accuracy of MSCT coronary angiography with 64-slice technology:first experience.Eur Heart J 2005;26:1482-1487.
23.Schroeder S,Kopp AF,Baumbach A,et al.Noninvasive detection and evaluation of atherosclerotic coronary plaques with multislice computed tomography.J Am Coll Cardiol 2001;7:1430-1435.
24.Leber AW,Knez A,von Ziegler F,et al.Quantification of obstructive and nonobstructive coronary lesions by 64-slice computed tomography:a comparative study with quantitative coronary angiography and intravascular ultrasound.J Am Coll Cardiol 2005;46:147-154.
25.Mollet NR,Cademartiri F,van Mieghem CA,et al.High-resolution spiral computed tomography coronary angiography in patients referred for diagnostic conventional coronary angiography.Circulation 2005;112:2318-2323.
26.Mollet NR,Hoye A,Lemos PA,et al.Value of preprocedure multislice computed tomographic coronary angiography to predict the outcome of percutaneous recanalization of chronic total occlusions.Am J Cardiol 2005;95:240-243.
27.Gilard M,Cornily JC,Rioufol G,et al.Noninvasive assessment of left main coronary stent patency with 16-slice computed tomography.Am J Cardiol 2005;95:110-112.
28.Schmitt R,Froehner S,Brunn J,et al.Congenital anomalies of the coronary arteries:imaging with contrastenhanced,multidetector computed tomography.Eur Radiol 2005;15:1110-1121.
29.Leber AW,Knez A,Becker A,et al.Accuracy of multidetector spiral computed tomography in identifying and differentiating the composition of coronary atherosclerotic plaques:a comparative study with intracoronary ultrasound.J Am Coll Cardiol 2004;43:1241-1247.
30.Achenbach S,Moselewski F,Ropers D,et al.Detection of calcified and noncalcified coronary atherosclerotic plaque by contrast-enhanced,submillimeter multidetector spiral computed tomography:a segment-based comparison with intravascular ultrasound.Circulation 2004;109:14-17.
31.Becker CR,Nikolaou K,Muders M,et al.Ex vivo coronary atherosclerotic plaque characterization with multidetector-row CT.Eur Radiol 2003;13:2094-2098.
32.Sato Y,Matsumoto N,Ichikawa M,et al.Efficacy of multislice computed tomography for the detection of acute coronary syndrome in the emergency department.Circ J 2005;69:1047-1051.
33.Pundziute G,Schuijf JD,Jukema JW,et al.Evaluation of plaque characteristics in acute coronary syndromes:non-invasive assessment with multi-slice computed tomography and invasive evaluation with intravascular ultrasound radiofrequency data analysis.Eur Heart J.2008 Oct;29(19):2373-81.
34.Motoyama S,Kondo T,Anno H,et al.Atherosclerotic plaque characterization by 0.5-mm-slice multislice computed tomographic imaging.Circ J 2007;71:363-6.
35.Hammer-Hansen S,Kofoed KF,Kelbaek H.Volumetric evaluation of coronary plaque in patients presenting with acute myocardial infarction or stable angina pectoris-a multislice computerized tomography study.Am Heart J.2009,157(3):481-7.
36.Cademartiri F,Mollet NR,Lemos PA,et al.Impact of coronary calcium score on diagnostic accuracy for the detection of significant coronary stenosis with multislice computed tomography angiography.Am J Cardiol 2005;95:1225-1227.
37.White CS,Kuo D,Kelemen M,et al.Chest pain evaluation in the emergency department:can MSCT provide a comprehensive evaluation?AJR Am J Roentgenol 2005;185:533-540.
38.Cademartiri F,Mollet NR,Runza G,et al.Influence of intracoronary attenuation on coronary plaque measurements using multislice computed tomography:observations in an ex vivo model of coronary computed tomography angiography.Eur Radiol 2005;15:1426-1431.
39.Morin RL,Gerber TC,McCollough CH.Radiation dose in computed tomography of the heart.Circulation 2003;107:917-922.
40.Mario Petrettaa,Pierluigi Costanzob,Wanda Acampac.Noninvasive assessment of coronary anatomy and myocardial perfusion:going toward an integrated imaging approach.J Cardiovasc Med.2008,9:977-986.
41.Han SC,Fang CC,Chen Y.Coronary computed tomography angiography---a promising imaging modality in diagnosing coronary artery disease.J Chin Med Assoc.2008 May;71(5):241-6.