16层螺旋计算机断层扫描对冠状动脉的无创成像

Zhang Zhu-hua, Jin Zheng-yu, Li Dong-jing, Lin Song-bai, Zhang Shu-yang, Kong Ling-yan, Wang Yun, Wang Lin-hui, Zhao Wen-min, Mou Wen-bin, Zhang Li-Ren, Zhu Wen-ling, Ni Chao, Ren Hua, Yu Hong-quan, Miao Qi, Fang Qi

Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730.

Chin Med Sci J. 2004 Sep;19(3):174-9.

OBJECTIVE

To evaluate the value of 16-slice spiral CT in the demonstration of coronary artery and in the diagnose of coronary artery stenosis.

METHODS

Plain and enhanced CT scans were performed with a 16-slice CT scanner (Sensation 16, Siemens, Germany) in 230 patients with suspected coronary heart disease (CHD). Parameters of the plain scan were: 120 kV, 133 mA, slice collimation 16 mm x 1.5 mm, rotation time 0.42 seconds, increment 1.5 mm, and slice width 3 mm. Parameters of the enhanced scan were: 120 kV, 500 mA, slice collimation 16 mm x 0.75 mm, rotation time 0.42 seconds, increment 0.5 mm, and slice width 1 mm. Enhanced CT scan was performed with a rapid intravenous injection of 100 mL iothalamate meglumine (Ultravist) (370 mgI/mL) or Omnipaque (350 mgI/mL) and 30 mL 0.9% NaCl chaser bolus at a flow rate of 3.5 mL/s. Calcium scoring with plain scan images and two and three dimensional reconstruction with enhanced scan images were made in all cases, among which 30 cases underwent conventional coronary angiography. Demonstration of coronary arteries and their stenosis were evaluated and the factors that might influence the image quality were analyzed.

RESULTS

Coronary calcium scores were calculated and coronary artery was demonstrated in our study. In the evaluation of image quality with volume rendering technique (VRT) images, 78.3% of the images were of the first class, 12.2% the second class, and 9.6% the third class. Multi-planar reconstruction (MPR) and maximal intensity projection (MIP) were better than VRT in the demonstration of small branches. The image quality was related to the heart rate, with or without arrhythmia, and breath-hold ability of patients. Comparative study of the stenosis of coronary arteries in 30 cases showed that the sensitivity and specificity of 16-slice coronary CT angiography (CTA) to diagnose significant stenosis were 95.8% and 94.8% respectively.

CONCLUSION

As a non-invasive and quick method, 16-slice coronary CTA is sensitive and specific to diagnose the stenosis of coronary arteries and can be used as a screening method in the diagnosis of CHD.

目的

评估16层螺旋CT在显示冠状动脉及诊断冠状动脉狭窄方面的价值。

方法

使用16层CT扫描仪（德国西门子公司的Sensation 16）对230例疑似冠心病（CHD）患者进行平扫及增强CT扫描。平扫参数为：120 kV，133 mA，层厚16 mm×1.5 mm，旋转时间0.42秒，层间距1.5 mm，层宽3 mm。增强扫描参数为：120 kV，500 mA，层厚16 mm×0.75 mm，旋转时间0.42秒，层间距0.5 mm，层宽1 mm。增强CT扫描时经静脉快速注射100 mL碘海醇（优维显）（370 mgI/mL）或欧乃派克（350 mgI/mL），随后以3.5 mL/s的流速注射30 mL 0.9%氯化钠溶液冲管。所有病例均利用平扫图像进行钙化积分，并利用增强扫描图像进行二维及三维重建，其中30例患者接受了传统冠状动脉造影检查。评估冠状动脉的显示情况及其狭窄程度，并分析可能影响图像质量的因素。

结果

本研究计算了冠状动脉钙化积分并显示了冠状动脉。在利用容积再现技术（VRT）图像评估图像质量时，78.3%的图像为一级，12.2%为二级，9.6%为三级。在显示小分支方面，多平面重建（MPR）和最大密度投影（MIP）优于VRT。图像质量与患者的心率、有无心律失常及屏气能力有关。对30例患者冠状动脉狭窄情况的对比研究显示，16层冠状动脉CT血管造影（CTA）诊断显著狭窄的敏感度和特异度分别为95.8%和94.8%。