【摘要】 目的 探讨HDCT血管造影(HDCTA)显示冠状动脉支架内再狭窄(ISR)的能力。方法 回顾性分析冠状动脉支架术后行CAG及HDCTA 93例,以CAG定量分析结果为参照,评价HDCTA诊断冠状动脉ISR的敏感性、特异性、阳性预测值及阴性预测值和诊断符合率。对CT冠状动脉成像质量进行评分,分析HDCTA对左前降支冠状动脉节段的支架显示能力,支架直径以及心率对HDCTA成像质量和诊断性能的影响。结果 93例159枚支架中,CAG证实21枚存在ISR,HDCTA诊断支架内再狭窄19枚,其中3枚狭窄程度被高估,另有5枚支架因临近钙化灶等因素而被误判为再狭窄。HDC TA诊断ISR的敏感性、特异性、阳性预测值、阴性预测值及诊断符合率分别为90.5%、96.4%、79.2%、98.5%、95.6%。成像质量为4分的支架75枚(47.1%),3分33枚(20.8%),2分27枚(17%),1分及以下24枚(15.1%)。左前降支近段较中、远段支架、直径≥3.0 mm较与直径<3.0 mm支架以及心率<66次/min同心率≥66次/min病例支架成像质量差异有统计学意义(P<0.05)。支架直径大、心率慢、支架在血管近端时成像质量更优。结论 HDCTA为一种简便、有效、无创性检查,可用于冠状动脉支架置入术后的随访观察。更多还原

【Abstract】 Objective To explore the accuracy of high definition computed tomography angiography(HDCTA) in the evaluation of coronary in-stent restenosis.Methods 93 patients with 159 implanted coronary stents who underwent both HDCTA and CAG were included in the study.The sensitivity,specificity,positive predictive value(PPV),negative predictive value(N PV) and diagnostic accordance rate of HDCTA were calculated.The imaging quality was analyzed by visual estimation.Possible factors that influenced the diagnostic accuracy of HDCTA were evaluated,which included stent location,stent diameter and heart rate in the patients with left anterior descending branch stents.Results Restenosis was found in 21 stents by CAG and 19 stents by HDCTA.The false positive and false negative were 5 and 3,respectively.Sensitivity,specificity,PPV,NPV and diagnostic accordance rate were90.5%,96.4%,79.2%,98.5% and 95.6% respectively.The image quality was 4 score in 75 stents(47.1%),3 score in 33(20.8%),2 score in 27(17%),≤1 score in 24(15.1%).The image quality of proximal segments,large stents(≥3.0 mm) and slow heart rate(<66 beast per minute) was significantly better than that of distal segments,small stents(<3.0 mm) and fast heart rate(≥66 beast per minute).Conclusion HDCTA is a convenient,efficient and non-invasive method for follow-up after implantation of the coronary artery stents.更多还原