The Diagnostic Value Of 64-slice Computed Tomography Virtual Endoscopy In Coronary Artery Diseases

Purpose: To evaluate the diagnostic value of 64-slice computed tomography virtual endoscopy in coronary artery diseases.Methods: We respectively discussed 37 patients with cardiovascular diseases or suspected coronary artery diseases who underwent the computed tomography and digital subtraction angiography (33 cases with coronary artery diseases, 3 cases after the coronary artery stent surgery, 1 case with the bypass surgery). We post-processed the raw data of these patients on workstation with the fly-through software to form the virtual images, and then to compare the results with digital subtraction angiography results.Results: 1. We separated the coronary arteries into 518 segments with 14 segments method recommended by American Heart Association, among which 448 segments reached the request of the evaluation of the images, which was moderately accordance with the DSA diagnose results(Kappa=0.566).2.Set the DSA results as the standard, as to mirco, mild, medium, severe and occlusion the sensitivity, specificity , positive predictive value and negative predictive value for CTVE respectively were 33.33%,89.67%,5.00%,98.80%,50.00%,95.47%,22.73%,98.62%,63.64%,98.45%,53.85%,98.96%,67.50%,99.50%,93.10%,96.84%,71.43%,99.77%,83.33%,99.55%. 3 .Among 368 normal segments, 330 segments present even ring configuration , and same pseudo-color; 27 segments were misdiagnosed as different disagree stenosis for viewing calcified plaque in CTVE images; 11 segments were misdiagnosed as soft plaque for irregular cavity. The number of stenostic segments was 80 segments, and the right number for the diagnose was 41 segments, among which 22 segments were with calcified plaque, displaying massive pseudo-color morphology; 14 segments showed that the cavity were partly lost or presenting the irregular bulge; 5 segments were with occlusion; 5 stents in 3 cases were all detected. The by-pass vessel was detected. 1 case with abnormal right coronary artery orifice was detected, and no stenosis found. 4 . Set the DSA results as the standard, and define more or equal to 50% stenosis coronary artery as positive results, and less than 50% as negative results, we found that the sensitivity , specificity, positive and negative predictive value of VE to identity more or equal to 50% stenosis coronary artery was 85.25%,98.45%,89.66,97.69%, and the Kappa value for the CTVE and DSA results was 0.871. Conclusion: 64-slice computed tomography virtual endoscopy can display the coronary artery cavity well, and had a relatively high misdiagnosed rate for micro and mild stenosis, and had a relatively accuracy diagnosis for medium,severe stenosis and occlusion; in some degree, CTVE images can recover the character of the stenosis to guide the clinical treatment; CTVE had a high sensitivity for detecting stent.