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目的比较64层螺旋CT(MSCT)和心肌灌注显像(MPI)评估钙化和非钙化冠状动脉狭窄的的价值。方法对61例冠心病(CAD)患者(疑诊50例,确诊11例)进行64层MSCT检查,并均在30 d内行冠状动脉造影(CAG)和MPI检查。结果 MSCT评估钙化段和非钙化段血管狭窄程度的准确率分别为66.2%和77.1%。MSCT诊断轻度钙化组CAD患者的灵敏度、特异性、阳性预测值、阴性预测值和准确性分别为88.0%、84.6%、91.6%、78.5%、86.8%,中重度钙化组为87.5%、57.2%、87.5%、57.2%、78.3%;MPI诊断轻度钙化组CAD患者的灵敏度、特异性、阳性预测值、阴性预测值和准确性分别为80.0%、76.9%、86.9%、66.6%、78.9%,中重度钙化组为87.5%、85.7%、93.3%、75.0%、86.9%。两种方法诊断CAD差异无统计学意义(P>0.05)。结论冠状动脉钙化影响MSCT对冠脉血管狭窄程度和CAD诊断的评估。联合应用MPI和MSCT可提高诊断价值,尤其对于严重钙化冠状动脉。
Objective To compare the value of 64-slice spiral CT (MSCT) and myocardial perfusion imaging (MPI) in the evaluation of calcified and non-calcified coronary artery stenosis. Methods Sixty-six patients with coronary heart disease (CAD) were examined by 64-slice MSCT in 50 suspected and 11 diagnosed patients. All patients underwent coronary angiography (CAG) and MPI examination within 30 days. Results The accuracy of MSCT in assessing the degree of vascular stenosis in calcified and non-calcified segments was 66.2% and 77.1%, respectively. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of MSCT in the diagnosis of mild calcification group were 88.0%, 84.6%, 91.6%, 78.5% and 86.8% respectively, and those in moderate and severe calcification group were 87.5% and 57.2 %, 87.5%, 57.2% and 78.3% respectively. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of MPI in patients with mild calcification were 80.0%, 76.9%, 86.9%, 66.6%, 78.9 %, Moderate to severe calcification group was 87.5%, 85.7%, 93.3%, 75.0%, 86.9%. There was no significant difference between the two methods in diagnosis of CAD (P> 0.05). Conclusion Coronary artery calcification affects the assessment of the degree of coronary artery stenosis and CAD diagnosis by MSCT. The combination of MPI and MSCT can improve diagnostic value, especially for severely calcified coronary arteries.