| 摘要: |
| 目的:评价64层螺旋CT血管造影（CTA）在冠状动脉支架植入术后再狭窄诊断中的应用价值。方法:采用64层螺旋CT对60例冠状动脉支架植入术后患者可评估的115枚冠状动脉支架及支架近端、中段及远端共345节段进行重建和分析，以选择性冠状动脉造影（SCA）结果为金标准，评价其诊断冠心病支架植入术后再狭窄的敏感性和特异性。结果:CTA清晰显示了冠状动脉支架植入的部位、支架长短、支架部位冠状动脉狭窄情况及引起狭窄斑块的性质。CTA发现支架内引起狭窄病变39处，其中钙化病变8处，非钙化病变31处；支架近端狭窄25例，中段狭窄7例，远端狭窄7例。SCA发现支架内狭窄病变42处，其中钙化病变9处，非钙化病变33处；支架近端狭窄26例，中段狭窄8例，远端狭窄8例。SCA示冠状动脉支架内狭窄42节段，CTA正确诊断36节段，漏诊6节段，误诊3节段，敏感性85.71%，特异性99.01%，阳性预测率92.31%，阴性预测率98.04%,准确率97.39%。其对支架近端病变敏感性及特异性最高，分别达到96.15%和100%；近端支架内狭窄占总再狭窄率的64.10%。结论:CTA能够清晰显示冠状动脉内支架再狭窄的情况，对冠状动脉支架植入术后患者再狭窄的诊断有较高的准确性，能准确判断支架狭窄部位以及引起狭窄病变性质，可以作为冠状动脉支架植入术后患者的一种无创性随访手段。 |
| 关键词: 支架；冠状动脉再狭窄；冠状血管造影术 螺旋CT血管造影术 |
| DOI：10.3724/SP.J.1008.2008.01355 |
| 投稿时间：2008-07-28修订日期：2008-09-04 |
| 基金项目: |
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| Application of 64-slice spiral coronary CT angiography in diagnosis of restenosis in patients with coronary heart disease after stenting |
| HE Yi-wen*,QIN Yong-wen,XIAO Yi |
| (Department of Cardiology，Changhai Hospital，Second Military Medical University，Shanghai 200433，China) |
| Abstract: |
| Objective:To evaluate the clinical value of 64-slice spiral coronary CT angiography (CTA) in diagnosis of in-stent restenosis （ISR）after percutaneous coronary intervention(PCI) in patients with coronary artery disease.Methods: CTA was used to reconstruct and analyze the 345 segments (each stent was divided into three segments: proximal,middle and distal) of 115 stents in 60 patients with coronary heart disease after PCI.The results of selective coronary angiography (SCA) were taken as the golden standard to evaluate the sensitivity and specificity of CTA in diagnosis of ISR after PCI.Results: CTA clearly showed the location and length of the stents,the stenosis at stent and the characteristics of restenosis plaques.Thirty-nine in-stent restenosis lesions were found by CTA,including 8 calcified lesions and 31 non-calcified lesions.There were 25 lesions at the proximal end of the stent,7 at the middle and 7 at the distal end.Forty-two lesions were found by CTA,including 9 calcified lesions and 33 non-calcified lesions,with 26 at the proximal end,8 at the middle and 8 at the distal end.CTA correctly diagnosed 36 segments,missed 6,and misdiagnosed 3.The sensitivity,specificity,PPV,NPV and accuracy of CTA were 85.71%,99.01%,92.31%,98.04% and 97.39%, respectively.CTA had the highest sensitivity and specificity for diagnosis of the proximal ISR,being 96.15% and 100%,respectively.Proximal stent restenosis accounted for 64.10% of the total.Conclusion: CTA can clearly demonstrate the in-stent restenosis and has a high accuracy in diagnosing restenosis after PCI.CTA is a safe,simple and reliable noninvasive diagnostic method for diagnosis of in-stent restenosis after PCI. |
| Key words: stents coronary restenosis coronary angiography spiral computed tomography angiography |
