The Value Of64-slice Computed Tomography An-giography In The Diagnosis Of Coronary Heart Disease

ObjectiveThe purpose of was to evaluate the accuracy of64-slice computed tomographycoronary angiography(64SCTCA) to detect the proximal middle segments of coronarystenosis in patients with coronary artery disease(CAD),compared with coronary arteryangiography(CAG),the reason of dismatching for the results of64SCTCA and CAG wasanalyzed,and plaque character was preliminary evaluated.Taking CAG as the standard,theaccuracy of64SCTCA for diagnosis of coronary In-Stent Restensis was evaluated.Materials and MethodsFrom April2011to December2012,120patients subjected to64SCTCA wereenrolled in TaiShan Medical College affiliated hospital imaging center,including22patients with clinical diagnosis of coronary heart disease (CHD) were examined by both64SCTCA and CAG, CT scan images were transmited to AW4.4post-processingworkstation for processing. The examination results of64SCTCA and CAG were analyzedrespectively by two radiologists and two cardiologists, who don’t know the opponentresults.The results of two methods were used for statistical comparison.18patients with followed-up of percutaneous coronary interventions(PCI) wereexamined by both64SCTCA and CAG,The examination results of64SCTCA and CAGwere analyzed respectively by two radiologists and two cardiologists, who don’t know theopponent results.The results of two methods were used for statistical comparison.Results1.102patients (excluding18patients with PCI),3patients (2.9%) were unevaluablebecause of poor image quality.The dominance was right in66.7%(67/99), balanced in28.3%(28/99), left in4.1%(4/99). There was one diagonal branch in27.3%(27/99), two diago-nal branches in61.6%(61/99), and more than two in11.1%(11/99),no diagonal branchwas not found. There was one marginal branch in30.3%(30/99), two in53.5%(53/99), more than two in16.2%(16/99), no marginal branch was not found.This experiment found11(11.1%) patients with myocardial bridging,1(1%) patient with coronary artery aneurysm,1(1%) patients with the anomalies of origin and course.2.99patients examined by64SCTCA were detected409atheromatous plaques,c-alcified plaques in106, non-calcified plaques in218, mixed plaques in85.Coronary arteryatheromatous plaques were mainly distributed in left anterior descending (LAD)artery,prox-imal and middle segment,next in proximal and middle segment of right coronary artery(RCA),proximal segment of left circumflex(LCx).3.With proximal and middle segment of RCA,left main coronary artery(LM),proximal and middle segment of LAD, proximal segment of LCx as the rese-archobjects,2patients were unevaluable because of poor image quality,20patients(105coronary segments,87.5%) with CHD can be used for the analysi-s.Taking the CAG asthe gold standard,the sensitivity,specificity,positive and negative prediction values indetecting stenotic lesions of≥50%with the64SCTCA were79.2%(19/24),92.6%(75/81),76.0%(19/25),93.8%(75/80). Two methods had no statistically significant difference indetecting stenotic lesions of≥50%(P=0.870，P＞0.05).4.18patients with35implanted coronary stents,32(91.4%) stents were assessable w-ith64SCTCA.2stents were located in the LM,18stents in the LAD,4stents in the LCx,8stents in the RCA.Taking the CAG as the gold standard,the sensitivity,specificity,positiveand negative prediction values in detecting ISR were75.0%(6/8),87.5%(21/24),60.0%(6/10),95.5%(21/22).Two methods had no statistically significant difference indetecting ofISR(P=0.396, P>0.05).Conclusion1.64SCTCA has outstanding clinical application value in diagnosis of the proximaland middle segments of coronary stenosis in patients with CHD,and coronary In-StentRestenosis.As a kind of noninvasive examination method, it can be used as a screening toolbefore interventional therapy in patients with CHD and a follow-up tool afterinterventional therapy.2.64SCTCA will preliminary provide the nature of the atherosclerotic plaque forclinical, it is helpful for clinical intervention and treatment in time.3. A variety of post-processing methods of64SCTCA can more visualized displaycoronary artery anatomy and congenital malformation to provide effective method forclinical diagnosis.