|
The first part of 64-slice MSCT detected in patients with coronary artery calcified plaque purpose, the application of 64-slice spiral CT evaluation of patients with coronary artery calcified plaque, calcified plaque and / or coronary artery stenosis. 2, combined with the clinical features, assessment of the prognostic significance of non-calcified coronary plaque on cardiovascular disease. 3 to determine the incidence of non-calcified plaque in coronary selected population. Method 1, the object of study: Select between October 2005 to January 2007, consecutive patients meet the inclusion criteria of the treatment at the German Heart Center, a total of 161 cases. 2, the object of study is significant CAD medium danger factors: (1) chest pain or breathing difficulties symptoms but ECG load test negative; (2) no chest pain symptoms but ECG load test positive or; (3) no chest pain symptoms, ECG The load test was positive, but intermittent arrhythmia. 3, the object of study exclusion criteria are (1) known coronary artery disease, (2) chest pain associated with myocardial ischemia test positive; (3) patients with arrhythmia, is not suitable for ECG-gated MSCT scanning. CT scanner: Siemens Sensation 64 CT models (Sensation 64 Cardiac, Siemens Medical Solutions). 5, the scan parameters are as follows: The number of layers × collimator width 64 × 0.6 mm the tube current 60mAs, voltage 120 kV, gantry rotation time 330 ms, pitch 0.2. Rack per revolution can get a 64-layer data, each layer thickness of 0.6 mm, while increasing the periodic z-axis fly-focusing technology. 6, statistical analysis of non-continuous variables are expressed as a percentage, taking the difference between the chi-square test or Fisher's exact test. P lt; 0.05 suggesting significant statistically significant. Results of coronary artery calcification and non-calcified plaque distribution of 161 patients with coronary MSCT imaging. 108 CAD patients, 48 ??patients (44%) had coronary artery calcified plaque, 38 cases of both non-calcified plaque associated with coronary artery calcification. 63 patients (39%) patients had no detected coronary artery calcification in 63 patients, 10 patients (16%) patients with coronary MSCT development observed in the non-calcified plaque, and these non-calcified plaque in these patients suffering from coronary only manifestation of arterial atherosclerosis. 98 (61%) patients with calcified plaque, of which 38 cases (39%) were also detected in patients with non-calcified plaque, no non-calcified plaque in the other 60 cases (61%) patients with coronary MSCT imaging examination ; 108 CAD patients with coronary artery calcified plaque or concomitant coronary artery calcification, accounting for 30% of all 161 patients enrolled in the study patients. 2, non-calcified plaque and no non-calcified plaque in patients with clinical features of non-calcified plaque and traditional cardiovascular disease risk factors, such as age, gender, body mass index, blood pressure, smoking, and PROCAM integration method is used to estimate 10-year risk of cardiovascular disease. There is a strong tendency to diabetes patients with non-calcified plaque, while there was significantly increased total cholesterol and LDL levels, but the inflammatory marker CRP levels were also significantly increased. According to the plaque density value, about half of the non-calcified plaque is obvious lipid-rich plaques. Selected patients with non-calcified plaque no difference? Blockers, ACE inhibitors, diuretics and calcium antagonists, and the use of his bite significantly lower class. MSCT examinations showed the degree of coronary artery calcification in patients with non-calcified plaque than patients with non-calcified plaque calcification extent for some light, but the two groups no significant difference (ASE: 80 [9, 246] vs 170 [17, 554]; non-calcified plaque in patients vs. non-calcified plaque in patients, P = 0.12). 3,64-slice MSCT diagnosis of coronary artery stenosis of 64-slice MSCT coronary angiography of QCA results by the same coronary segments one-on-one analysis. Analyzed a total of 257 coronary segments above, the sensitivity differ according to the degree of stenosis, we analyzed the degree of stenosis is lt; 50% gt; 50% and GT; 75% of the three sub-groups in the coronal artery proximal and middle, the results of the sensitivity is 80%, 75% and 88%, respectively; in the coronary remote sensitivity are 76%, 67% and 80%; summary of all segments of meta-analysis, the sensitivity is 79 %, 73% and 80%; specificity in terms of coronary artery proximal, middle or distal, or meta-analysis summary of all segments are 97% to 97%. Conclusion 1, a medium level of risk in patients with CAD, 64-slice MSCT can detect non-calcified coronary atherosclerotic plaque. 2, the application of non-invasive coronary CT angiography assessment of non-calcified plaque on coronary heart disease risk stratification has an important help. 3,64-slice MSCT diagnosis of coronary artery stenosis with high accuracy, especially more specific, suggesting that 64-slice MSCT has a great value in screening for coronary heart disease. The second part of the 64-slice spiral CT assessment of patients with coronary artery bypass grafts purpose to evaluate the diagnostic value of 64-slice CT angiography for coronary artery bypass grafts. 2, accompanied by arrhythmia in patients with diagnostic value. 3, the evaluation of the non-selected patients in actual clinical work, more accurate evaluation of the diagnostic value of 64-slice spiral CT angiography. Method 1, the object of study: February 2006 to February 2007, 138 consecutive patients after CABG patients with suspected coronary artery bypass graft vascular disease treatment. 2, the exclusion criteria of the study are: contrast agent known allergy or severe renal failure (Scr gt; 1.8mg/dl). Accompanied by arrhythmia patients in the CT scanning process are also included in the study observed. 3, Siemens Sensation 64 CT models (Sensation 64 Cardiac, Siemens Medical Solutions). 4, the scan parameters are as follows: the number of layers × collimator width 64 × 0.6 mm the tube current 60mAs, voltage 120 kV, gantry rotation time 330 ms, pitch 0.2. Rack per revolution can get a 64-layer data, each layer thickness of 0.6 mm, while increasing the periodic z-axis fly-focusing technology. Invasive angiography with quantitative coronary analysis (QCA) to determine the stenosis of coronary artery bypass graft vasculopathy, aware of the MSCT angiography heart disease expert evaluation the result by two. Taken offline automatic edge monitoring systems analysis digital angiographic image in the center of the QCA central laboratory. 6, statistical analysis of count data expressed as a percentage (%), measurement data are expressed as mean ± standard deviation (mean ± SD). MSCT diagnostic results with the sensitivity, specificity, positive predictive value and negative predictive value, and the corresponding 95% confidence interval. MSCT angiography prompt lumen stenosis ≥ 50% indicates that coronary artery bypass grafts obvious lesions. Categorical variables using chi-square test; continuous variables with the t test. P lt; 0.05 suggesting significant statistically significant. 1.138 cases of patients with a total of 418 coronary artery bypass grafts. 12 previously implanted intravascular metal stent excluded, 406 vascular included in the analysis, transplant vascular evaluable rate was 98% (397/406). MSCT assessment of coronary artery bypass graft sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy: 97% (113/116), 97% (273/281), 93% (113 / 121) and 99% (273/276), the diagnostic accuracy of 97%; For complete occlusion of blood vessels sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy rate is 100%; coupled with the exclusion of vascular sensitivity of the meta-analysis is 90%. MSCT assessment vein bypass graft sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy: 98% (253/259), 98% (88/89), 96% (160 / 164), 96% (88/92) and 99% (160/161), the diagnostic accuracy of 98% (248/253). MSCT assessment artery bypass graft sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy: 98% (144/147), 93% (25/27), 97% (113 / 117), 86% (25/29), 98% (113/115) diagnostic accuracy was 96% (138/144). 5, according to each patient evaluation analysis MSCT assessment of coronary artery bypass grafts select image analysis, MSCT diagnostic sensitivity, specificity, positive predictive value and negative predictive value were 100% (95% CI: 94 -100%), 92% (95% CI: 82-97%), 93% (95% CI: 85-97%) and 100% (95% CI: 93-100%). If you include the image can not be evaluated in patients with a summary of diagnostic analysis, the sensitivity, specificity, positive predictive value, and negative predictive values ??were 100% (95% CI: 94-100%), 87% (95% CI: 76 -93%), 89% (95% CI: 79-94%) and 100% (95% CI: 93-100%). MSCT on the assessment of the surrounding coronary MSCT diagnosis significantly narrow the sensitivity, specificity, positive predictive value and negative predictive value were 87%, 96%, 57% and 99% diagnostic accuracy is 94%; non-evaluate around the coronary artery, including for the meta-analysis, MSCT diagnosis significantly narrow the sensitivity, specificity, positive predictive value and negative predictive value were 94%, 74%, 30% and 99%. 7, 42 cases (30%) patients with arrhythmia, involving a total of 131 vascular arrhythmia effect on accuracy during the scanning process. In patients with arrhythmia, evaluation of coronary artery bypass transplant vascular significantly lower than the number of arrhythmia patients (95% vs. 100%, p lt; 0.01) However, in the evaluation of vascular diagnostic accuracy is not due to arrhythmia reduced. 8, heart rate, heart rate effect on accuracy lt; the 65bpm patients grafts can be evaluated ratio of 100% (275/275). The average heart rate of 50 cases (36%) grafts ≥ 65bpm patients evaluable proportion is 94% (135/143), there is a significant difference between the two, p lt; 0.01. In the evaluation of coronary artery bypass graft, regardless of the patient's heart rate ≥ 65bpm or lt; 65bpm, no significant difference in diagnostic accuracy. 9, body mass index on the accuracy of MSCT BMI more than 30kg/m2 obese patients diagnostic sensitivity, specificity, positive predictive value, and negative predictive values ??were 94%, 100%, 100% and 98%, while the BMI lt; 30kg/m2 patients with sensitivity, specificity, positive predictive value and negative predictive value were 99%, 96%, 91% and 99%. Conclusion 1.64-slice CT angiography is the evaluation of patients with coronary artery bypass graft patency more reliable non-invasive means of the diagnosis of coronary artery bypass graft has a high accuracy, accompanied by arrhythmia patients also has a high accuracy. Due to the increase in the 64-slice CT resolution, but also be able to accurate evaluation of bypass grafts around the coronary. 4 to further improve the temporal and spatial resolution of the CT for the evaluation of motion artifacts like more and vascular calcification in severe cases will be of great help.
|