| Part I Objective:To study the effects of vasodilator on the coronary artery lumen diameter and the image quality of64-slice spiral computed tomography coronary angiography (64-SCTCA). Methods:Two hundred possible coronary heart disease patients were recruited randomly.Thereinto,100patients were performed64-SCTCA without nitroglycerin spray (group A),the other100patients were examined with the administration of nitroglycerin spray (group B).The lumen diameters of right coronary artery (RCA,segments1～3), posterior descending coronary artery(PDA,segment4),left main(LM,segment5), left anterior descending coronary artery(LAD,segment6-8),left circumflex coronary artery(LCX,segmentll,13)were measured separately. The number of branches was counted. And the number of clinical side effects was evaluated also. Result:The differences of the coronary artery lumen diameter and the number of branches between the two groups were extremely significant through statistical analysis. The lumen diameters and the number of branches visualized were significantly larger in group B than in group A. The occurrence percentage of side effects in the two groups was not significantly different. Conclusion:Nitroglycerin spray can dilates the coronary arteries significantly and make more coronary artery branches visible at64-SCTCA while the number of clinical side effects was not increased.Part II Objective:To assess the influence of vasodilator on the accuracy of64-SCTCA for detection of obstructive coronary artery disease according to the criterion standard of invasive SCA. Methods:150patients with coronary artery disease who were undergoing both invasive SCA and MSCT were chosen randomly:75patients accepted64-SCTCA without nitroglycerin (group A), and75patients accepted64-SCTCA with nitroglycerin spray (group B). The stenosis degree of each lesion was quantitatively assessed. The quantitative values were compared respectively with the results of recent invasive SCA. Result:Compared with SCA, for noncalcified plaque and noncalcified component based mix plaque, MSCT underestimated the stenosis degree in group A and overestimated in group B, the bias of A and B group were-10.11%,+10.54%; For calcified plaque and calcified component based mix plaque, MSCT overestimated the stenosis degree in both two groups, the bias were+8.65%,+16.37%. The differences between the two groups were statistically significant. The two kinds of examination showed good correlation in both groups. The difference of related coefficient between the two groups was not statistically significant. Conclusion:It is prone to overestimate the stenosis degree using vasodilator in MSCT coronary angiography.Part III Objective:To assess the change of coronary plaque in patients with coronary artery disease who accept medical therapy and the application value of MSCT in follow-up of coronary plaque. Methods:9patients with coronary artery disease who accept medical therapy were enrolled. Each patient accepted twice64-SCTCA examination with6-18months intervals. The volume change of noncalcified plaques and noncalcified component based mix plaques were compared quantitatively between the two time examinations. Result:The total volumes of noncalcified plaques and mixed-plaques with more non-calcified component of two times before and after werel542.0mm3,1085.13mm3. Total plaque burden significantly decrease over6-18months among patients with medical therapy. Conclusion:Medical therapy can effectively control the progress of coronary artery disease and reduce the non-calcified plaque burden. MSCT has important application value in follow-up of coronary plaque. |
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