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The Value of 64-slice Spiral CT in the Diagnosis of Coronary Unstable Plaque

Author: LiLiPeng
Tutor: QiuChunGuang
School: Zhengzhou University
Course: Of Cardiovascular
Keywords: 64-slice CT Coronary angiography Unstable plaque hsCRP
CLC: R816.2
Type: Master's thesis
Year: 2007
Downloads: 212
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Abstract

The background and purpose of atherosclerotic plaque constitute unstable coronary disease pathophysiological basis, rather than the stability of atherosclerotic plaques (vulnerable plaques vulnerable plaque, VP) constitute unstable coronary disease The pathophysiological basis. More and more evidence that the severity of coronary lesions is mainly determined by plaque stability rather than the size. The stability of the plaque is the main decisive factors affect ACS development. So, how early identification of unstable plaques and treatment measures to stabilize is the goal of many scholars, the research focus in recent years. There are many kinds of traditional means of detection of the plaque and its stability such as: coronary angiography (coronary angiography, CAG); intravascular ultrasound (Intravascular ultrasound, IVUS); intravascular coronary angioscopy (coronaryangioscopy, CAS); elastography ultrasound (IVUS elastography); coronary guide wire temperature measurement, the above checks are invasive technique, mortality (0.15%) and complications (1.5%), and inspection fees. In the late 1990s, more and more evidence that the inflammatory process in the incidence of atherosclerosis process and play an important role in the atherosclerotic plaque stability. High-sensitivity CRP (High sensitivity Creactive protein, hsCRP) is a reliable marker of inflammation in coronary, with a high degree of sensitivity and accuracy as a reliable means of detection of unstable plaque. Inflammatory marker of unstable plaque just qualitative analysis, not quantitative intuitive evaluation. In recent years, with the multi-slice spiral CT (Multislice spiral CT, MSCT) and the advent of the ECG-gated technology, MSCT used in coronary imaging made possible new method of checking for coronary heart disease and shows good prospects for development . Some studies suggest that MSCT can make the noninvasive evaluation of coronary atherosclerotic plaque morphology and composition. In this study, based on hsCRP concentration determined selected unstable angina patients with plaque stability, with reference to the results of selective coronary angiography 64-slice CT quantitative detection of unstable plaque and the Distribution of accuracy. To explore the 64-slice spiral CT in the diagnosis of coronary artery the unstable plaque role and clinical significance. Methods from March 2006 to September 2006 our hospital of Cardiology hospital clinical diagnosis in patients with unstable angina pectoris 36 cases, including 22 males and 14 females, aged 37 ~ 76 (57.72 ± 8.88) years old. Braunwald unstable angina classification standard points: the grade Ⅰ 15 cases, 14 cases of grade II and III level seven cases. All patients underwent 64-slice CT coronary angiography, in accordance with the degree of coronary artery diameter stenosis divided into: <25% of normal, 25% to 50% for mild, 51% to 75% moderate, 76% severe . Based on the CT value of coronary plaque is divided into four categories: rich lipid plaque (also known as soft plaque) CT value <50HU fibrous plaque CT value 70 ~ 100HU, calcified plaque CT values> 130HU , mixed plaque lipids and calcification coexist plaque. Then underwent selective coronary angiography (CAG) check by two experienced interventional cardiologists physician joint analysis of the angiographic results and compare with 64MSCT diagnosis results, to analyze the number, location and severity of the unstable plaque. All selected objects second morning fasting blood collected on admission cubital vein 4ml, quantitative determination of hsCRP. Statistical Methods SPSS10.0 software package for statistical analysis. Results HsCRP between 3mg / L ~ 7mg / L (4.5 ± 1.11mg / l). 108 main coronary artery of 36 patients were a 64-slice CT and CAG checks, (1) CAG detected lesion count of 73; 64MSCT detected lesion count of 67. When comparing the two was not statistically significant (P> 0.05). As standard to the CAG, 64MSCT positive predictive value 80%, negative predictive value 97%, sensitivity 89%, specificity 94%, 6% false-positive and false-negative and 11%, accuracy of 91%. Compliance rate of 64-slice CT to detect lesions count were RCA72 LAD94%, LCX95, (2) to CAG as a standard the MSCT overall plaque detection rate of 79%; various branches near the middle of the spot The the block detection rate were RCA77%, 71%; LAD96%, 77%; LCX89%, 100%; the branch distal plaque detection rate ≤ 50% lower; RCA plaque detection rate is lower than the LAD and LCX. (3) 64MSCT detected 76 plaque, soft plaque accounted for 21.1%; the calcified plaque 26.3%; the mixed plaque 52.6%; fibrous plaque. Soft plaque 50% distributed in mild stenosis lesions, only 13% in severe stenosis lesions; the mixed plaque 65% distribution severe stenosis lesions. Different types of plaque in the comparison between the degree of stenosis P <0.05, statistically significant. Correction α (α '= 0.017) pairwise comparisons between mild, moderate, severe, mild - moderate P> 0.017 mild - not statistically significant; moderate - severe P <0.017 statistically significant; severe P <0.017 considered statistically significant. (4) 62.5% of the soft plaque distribution in Braunwald unstable angina classification class I patients, 18.8% mixed plaques Ⅲ grade; 55% of the grade Ⅲ patients, 15% in stage I patients. Different types of plaque in the overall classification between, P <0.05 considered statistically significant. Correction α (α '= 0.017) Ⅰ, Ⅱ grade, Ⅲ grade pairwise comparisons between grade Ⅰ - Ⅱ, Ⅱ - Ⅲ grade P> 0.017 was not statistically significant; Ⅰ - Ⅲ level between P <0.017 statistically significant. Thus, the mild stenosis lesions, mostly soft plaque, the severe stenosis mixed plaque lesions. Braunwald unstable angina the grading stage I patients with soft plaque and calcified plaque common; the grade Ⅱ patients with grade III mixed plaques were more common. Conclusion (1) 64MSCT coronary imaging of coronary artery stenosis and plaque quantitative diagnosis with high accuracy. (2) 64MSCT make noninvasive evaluation of coronary plaque morphology and composition. By a method of measuring plaque CT value to separate the different components of the plaque area and by descriptions plaque component qualitative evaluation of the stability of the plaque, soft plaque, calcified plaque, and mixed plaque having unstable sex. (3) mild stenosis lesions in soft plaque, severe stenosis mixed plaque lesions. (4) in Braunwald unstable angina to the grading stage I patients with soft plaque and calcified plaque common; class II, class III angina patients with mixed plaques more common.

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