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背景:许多初步研究结果表明,16层螺旋CT对冠状动脉狭窄的显示具有较高的准确性。目的:通过与冠状动脉造影对比评价多层螺旋CT诊断冠状动脉中、重度狭窄的准确性和局限性。设计、时间及地点:金标准对照观察的临床诊断实验,于2005-06/2006-03在首都医科大学宣武医院心脏科完成。对象:选择2005-06/2006-03首都医科大学宣武医院心内科收治的1个月内先后行64层螺旋CT和冠状动脉造影检查的临床诊断或可疑冠状动脉硬化性心脏病患者28例。方法:采用国际上通用的目测直径法,对选择性冠状动脉造影或多层螺旋CT显示冠状动脉狭窄进行定量评价。分别对28例患者的280个节段进行分析。主要观察指标:多层螺旋CT冠状动脉成像对冠状动脉狭窄的真阳性、真阴性、假阳性、假阴性以及灵敏度、特异度、准确度、阳性预测值、阴性预测值。结果:纳入的28例患者全部进入结果分析。依节段计算多层螺旋CT的准确性,其灵敏度、特异度、阳性预测值和阴性预测值分别为46.5%,97.6%,86.8%和84.3%。若去除其中31个冠状动脉节段由于严重钙化而影响诊断的因素,则多层螺旋CT的诊断灵敏度、特异度、阳性预测值和阴性预测分别为66.7%,98.6%,90.3%和93.6%。结论:多层螺旋CT冠状动脉成像是一种简便易行、安全可靠、风险小的无创性检查,对诊断冠状动脉硬化性心脏病尤其针对筛选冠状动脉硬化性心脏病而言有较好的前景,但也有一定局限性。
Background: Many preliminary studies have shown that 16-slice spiral CT shows a high degree of accuracy in the display of coronary artery stenosis. OBJECTIVE: To evaluate the accuracy and limitations of multi-slice spiral CT in the diagnosis of moderate and severe coronary artery stenosis by contrast with coronary angiography. DESIGN, TIME AND SETTING: The clinical trial of gold standard control was performed at the Department of Cardiology, Xuanwu Hospital, Capital Medical University from June 2005 to March 2006. PARTICIPANTS: A total of 28 patients with clinically diagnosed or suspected coronary heart disease who underwent 64-slice spiral CT and coronary angiography were enrolled within one month of the Department of Cardiology, Xuanwu Hospital, Capital Medical University from June 2005 to March 2006. Methods: Quantitative evaluation of coronary artery stenosis by selective coronary angiography or multi-slice spiral CT was performed by internationally accepted visual diameter method. 280 segments of 28 patients were analyzed. MAIN OUTCOME MEASURES: True positive, true negative, false positive, false negative and sensitivity, specificity, accuracy, positive predictive value and negative predictive value of MSCT coronary angiography in coronary artery stenosis. Results: All the 28 patients included in the result analysis. The sensitivity, specificity, positive predictive value and negative predictive value of MSCT were 46.5%, 97.6%, 86.8% and 84.3%, respectively. The diagnostic sensitivity, specificity, positive predictive value and negative predictive value of multi-slice spiral CT were 66.7%, 98.6%, 90.3% and 93.6%, respectively, if 31 coronary artery segments were excluded from the diagnosis due to severe calcification. Conclusion: Multislice CT coronary angiography is a simple, safe, reliable and low-risk noninvasive examination. It has a good prospect for the diagnosis of coronary heart disease, especially for the screening of coronary heart disease , But there are some limitations.