The Dignositic Value Of 256-Slice Spiral CT For Vulnerable Plaque

Objective:The important clinical change of coronary atherosclerosis is the formation of plaque,and the vulnerable plaque is an important stage.VP rupture and thrombosis can lead to acute coronary syndrome.ACS includes various types of unstable angina pectoris.Including non ST elevation myocardial infarction and ST elevation myocardial infarction.Vulnerable plaque instability due to plaque rupture,and secondary thrombosis can be dangerous for patients with myocardial infarction caused by the occurrence of acute coronary syndrome,especially at home and abroad is of great harm to heart disease.It is important to detect the vulnerability of the plaque as early as possible and to detect the acute occurrence of acute coronary syndrome.The purpose of this study was to evaluate the diagnostic value of 256-slice spiral CT and coronary angiography(CAG)in the diagnosis of vulnerable coronary plaques.Methods:January 35 patients with tipical clinical symptoms who were admitted in our hospital from January 2016-July 2016 for the study,including 24 males and 11 females,age range from 39 to 80.According to chest pain history,ECG changes and related laboratory results,patients with clear diagnosis were divided into the ACS group,except for non-ACS group.Patients were followed by 256-slice spiral CT coronary angiography and coronary angiography within one month.Coronary arteriosclerosis plaques are divided into hard plaques,fibrous plaques and soft plaques according to their inclusion.According to the reconstructed image of the thin layer,the type,number and CT value of the coronary plaque were observed by using the post-processing software for multi-level recombination,maximum density projection,surface imaging and volume reproduction imaging.Mainly to understand the vulnerability of plaques,to evaluate the lesion.Coronary angiography was used as the standard,and the degree of coronary artery stenosis was measured.To evaluate the sensitivity,specificity,positive predictive value and negative predictive value of 256-slice spiral CT to determine the degree of stenosis.And to analyze the relationship between acute coronary syndrome group and non-ACS group and coronary artery plaque vulnerability.Result:1.All of the 35 patients were evaluable for the coronary artery segments of the 315 segment.Coronary angiography coronary lesion segment number 129,256 slice spiral CT can detect coronary artery lesion segment 117,the differences had not statistical significance(P>0.05).Compared with coronary angiography,the detection sensitivity of 256 slice spiral CT was 93.6%,specificity was 94.3%,the positive predictive value was 84.6%,negative predictive value was 97%.The comparison for different degrees of narrow lesions detection had no statistical significance(P>0.05).2.Between the two groups,acute coronary syndrome group and non acute coronary syndrome group.coronary artery plaque: a total of 35 patients,all images can be analyzed,no complications occurred in the inspection process,the two group analysis of vascular lesions in 117 segments,315 segments.ACS group 68,soft plaques,49 in non ACS group,with a hard patch.3.In two groups patients,117 were found at the plaque lesions,coronary angiography was 129,including mild,moderate and severe stenosis were 18,54,45,mild and moderate stenosis were soft plaque and hard plaque mainly exist in severe stenosis.The proportion of hard plaque in the severe group was significantly higher than that in the mild and moderate stenosis group(P<0.05).The comparison for different had statistical significance.4.256-slice spiral CT detected soft plaque,fibrous plaque and hard plaque in the ACS group were 30,18,and 27,accounting for 40%,24%,36%.The proportion of soft plaque was significantly higher than that of non ACS group.The proportion of hard plaque was significantly lower than that of non ACS group(P<0.05).The comparison between soft patch group and hard plaques group had statistical significance.Conclusion:256-slice spiral CT coronary artery imaging can judge the coronary stenosis and the quantitative of coronary artery plaques with high accuracy,has a high coincidence rate with CAG.On the prevention and treatment of acute coronary syndrome caused by sudden death has a positive effect.