摘要
目的探讨患者心率、支架直径及支架壁厚度对64排螺旋CT冠状动脉造影(CTA)图像质量的影响。方法回顾性分析41例冠状动脉支架置入术患者64排螺旋CT冠状动脉造影图像,分析患者心率、支架直径及支架壁厚度对图像质量的影响,并与常规冠状动脉造影(CAG)金标准比较,评价CTA诊断支架内再狭窄(ISR)的准确性。结果本组41例患者共置入不锈钢药物洗脱支架82枚,CAG检出10枚(12.2%)发生ISR,14枚支架因图像质量差CTA无法评价。在可评估的68枚支架中:心率<70次/min有65枚(95.6%),直径支架≥3.0mm者54枚(79.4%),支架壁厚度<140μm者53枚(77.9%)。在不可评估的14枚支架中:心率≥70次/min有12枚(85.7%),支架直径<3.0mm有12枚(85.7%),支架壁厚度≥140μm者有13枚(92.9%)。68枚支架中,CAG检出6枚ISR,而CTA发现7枚ISR,其中2枚为假阳性,1枚假阴性,CTA对ISR的的诊断敏感性、特异性、阳性预测值和阴性预测值分别为83.3%、96.8%、71.4%和98.4%。结论 64排螺旋CT冠脉造影能准确评价冠状动脉支架内再狭窄,患者心率、支架直径及支架壁厚度影响CTA图像质量,慢心率、薄壁、大直径支架的可评估性更好。
Objective To investigate factors affecting the image quality of coronary angiography(CTA)with 64-detector spiral CT after coronary stent implantation.Methods 41 consecutive patients with previous cononary stent implantation with 82 stainless steel drug-eluting stents were included in this study to analyze whether the patient’s heart rate,the stent diameter and the stent wall thickness affected the CTA image quality.And then,we evaluated the accuracy of CTA in the diagnosis of in-stent restenosis(ISR)compared with the coronary angiography(CAG)as the'gold standard'.Results 10 ISRs were detected by CAG in the 82 stents,14stents could not be evaluated by CTA because of poor image quality.Of68 evaluable stents,there were 65stents(95.6%)with the paten’s heart rate <70beats per minute(bpm),54stents(79.4%)with stent diameter≥3.0mm,and 53stents(77.9%)with stent wall thickness<140μm.14 stents were unevaluable,of which there were 12stents(85.7%)in patients with heart rate≥70bpm and 12 with stent diameter<3.0mm,13stents(92.9%)with wall thickness≥140μm.Of 68 stents which could be assessed by CTA,6ISRs were detected by CAG,and 7by CTA which included 2false positive and 1false negative,and the diagnostic sensitivity,specificity,positive predictive value and negative predictive value of ISR with CTA were 83.3%,96.8%,71.4%and 98.4%,and the difference was no statistically significant(P >0.05)compared with CAG.Conclusion 64-detector Spiral CT Coronary Angiography can accurately evaluate in-stent restenosis of coronary artery.The heart rate of the patient,stent diameter and wall thickness of stent can affect image quality,the slower heart rate,thinner-walled and large diameter stent can be better assessed.
出处
《医学影像学杂志》
2015年第8期1348-1353,共6页
Journal of Medical Imaging
