128层螺旋CT与X线冠脉造影临床诊断价值的对比研究

目的：以X线冠状动脉血管造影（CAG）的检查结果作为金标准，探讨128层螺旋CT在冠状动脉疾病中的临床诊断价值。方法：截取我院2010年3月～2012年1月共56例患者，具有冠心病临床症状或有冠心病高危因素，行128层螺旋CT检查，并于3～12天内给予CAG检查。以CAG的检查结果作为金标准，评价CTA对冠状动脉粥样硬化斑块定量分析、定性分析的临床价值以及对冠状动脉开口异常检出的发现率。结果：根据128层螺旋CT显示，纳入的56例患者中，共672支冠状动脉节段可评价，其中正常505支，狭窄或闭塞167支，其中斑块引起狭窄或闭塞152支，冠脉开口异常4支。对照CAG检查结果，CTA诊断冠状动脉粥样硬化斑块时，在冠状动脉不同分支中，混合斑块发生率（55％）远较钙化斑块（27％）及软斑块（16％）高，左主干不同性质斑块总发生率（11％）及软斑块发生率（0）均低于左回旋支及右冠状动脉，差异具有统计学意义（P〈0．05）。根据CTA与CAG成像质量比较，CAG对斑块性质的确定准确性不如CTA，冠脉开口异常显示的准确性优于CAG。结论：128层螺旋CT作为一种无创成像方法，在冠脉粥样硬化斑块性质确定上优于X线冠脉造影，而且对于冠状动脉开口异常发现率（7％）好于X线冠脉造影，差异具有统计学意义（P〈0．05）。在某些程度上CTA可以选择性代替X线冠脉造影。

Clinical Diagnosis Value of 128-slice Spisal CT compared to X-ray CAG

Aim： To explore the value of 128-slice spiral CT in evaluating coronary artery disease by comparison with coronary arteriography. Methods： a total of 56 consecutive patients who showed coronary heart disease clinical symptoms or high risk factors in our hospital from March 2010 to January 2012, were given 128-slice spiral CT and given coronary arteriography in the 3-12 days. CAG results as the gold standard, evaluation of CTA coronaty atherosclerotic plaque the clinical value of quantitative analysis and qualitative analysis as well as to the coronary artery opening the discovery of abnormal detection rate. Result： according to the results of CTA, in 56 cases of patients, a total of 673 coronary artery segments can be evaluated, containing normal blood segments 505. 152 narrow or blocked segments caused by coronary artery plaques in 167 narrow or blocked and 4 abnormal coronary openings. In different branch of coronary artery, the incidence of mixed plaque than calcified plaques and soft plaque, the total incidence of different characteristics plaques in LMA （11%） and the incidence of soft plaque （0） are lower than those in LAD and RCA, and statistical difference was statistically significant （P 〈 0.05）. According to the CTA and CAG imaging quality, The accuracy of the plaques properties of CTA＇was better than that of CAG, opening coronary anomalies shows that the accuracy is better than that of the CAG. Conclusion： 128-slice spiral CT coronary angiography as a noninvasive imaging method, the determination of coronary atherosclerotic plaque characteristics in CTA was superior to X-ray CAG. Opening coronary anomalies shows that the accuracy is better than that of the CAG and statistical difference was statistically significant （P 〈 0.05）. In some extent, the CTA can selectively instead of X-ray coronary angiography.