北京生物医学工程

血管疾病的超声影像学研究血管内超声与64排螺旋CT分析冠状动脉斑块的对比研究

Assessment of Coronary Atherosclerotic Plaques Using Intravascular Ultrasound:Comparison with 64-Slice Computed Tomography

作者：杨娅王艳红李治安孙军燕张兆琪赵迎新周玉杰谢谨捷张小杉

单位：首都医科大学附属北京安贞医院(北京100029)

关键词：冠状动脉粥样硬化斑块；血管内超声；64排螺旋CT

分类号：

出版年·卷·期（页码）：2010·29·6（561-565）

摘要：

目的对冠状动脉病变患者进行血管内超声（IVUS）和64排螺旋CT（64MDCT）检查,评价两种检查手段在冠状动脉病变诊断中的应用价值。方法 24例临床怀疑或诊断为冠心病的患者接受冠状动脉64MDCT检查，并应用其工作站相关后处理技术对冠状动脉粥样斑块进行评估分析。一周内实施冠状动脉内IVUS检查，对冠状动脉病变进行定性和定量分析。结果分析病变血管52支，其中左主干24支，前降支21支，左回旋5支，右冠状动脉2支。IVUS显示有斑块病变的血管段为60段，64MDCT显示有斑块病变的血管样本57段，其中3段病变64MDCT诊断正常而IVUS显示为斑块早期病变。64MDCT对出现任何粥样硬化斑块节段诊断的敏感性为96%，特异性为94.7%。IVUS与64MDCT的管腔面积，外弹力膜面积、斑块面积的相关系数r分别为0.79、0.83、0.81。结论 IVUS能准确判断冠状动脉斑块的大小和性质。64MDCT作为非侵入性方法亦能显示管壁斑块的构成，判断病变的类型及程度，具有一定的敏感性和准确率。

Objective The purpose of this study was to compare the accuracy of 64-slice CT (64-MDCT) with that of intravascular ultrasound (IVUS) for the identification and quantitative analysis to coronary atherosclerotic plaques.Materials and Methods A total of 24 patients with suspected coronary atherosclerotic disease (CAD) were studied using contrast-enhanced 64-MDCT and IVUS within 1 week.The morphology，classification，and quantitative analysis of atherosclerotic plaques were compared between 64-MDCT and IVUS.Results Fifty two arteries satisfied with the diagnosis of atherosclerosis，24 LM(left main coronary artery)，21 LAD(left anterior descending coronary artery)，5 LCX(left circumflex coronary artery) and 2 RCA(right coronary artery) were included.Sixty segments with coronary atherosclerotic plaques were imaged and analyzed by IVUS and 57 segments by 64-MDCT.It was 3 segments were diagnosed differently by IVUS and 64-MDCT，which were early atherosclerotic plaques by IVUS while normal by 64-MDCT.It was indicated that the sensitivity and specificity of 64-MDCT to value coronary artery atherosclerotic plaque were 96% and 94.7%.The correlation coefficients between IVUS and 64-MDCT for determining vascular CSA，lumen CSA，and plaque burden were 0.85，0.82 and 0.77，respectively (P<0.01).Conclusions IVUS can identify the size and character of atherosclerotic plaques and also analyze quantitatively.64-MDCT is a noninvasive way to estimate the plaques and also has well sensibility and specificity.

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