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目的探讨冠状动脉病变自身因素对CTA评估血管狭窄程度准确性的影响。资料与方法60例临床拟诊疑为冠状动脉狭窄的患者同期行冠状动脉CT血管造影(CTA)和冠状动脉血管造影检查(CAG)。CTA扫描采用64层螺旋CT及回顾性心电门控技术,以CAG结果为金标准,采用双盲法评价CTA诊断冠状动脉狭窄的准确性,并分析各种冠状动脉病变自身因素对评价狭窄准确性的影响。结果CTA诊断冠状动脉轻、中、重度狭窄的敏感性分别为76.47%、77.97%和85.71%,钙化斑块是导致64层螺旋CT评价冠状动脉狭窄假阳性最重要的自身因素(18/28,占64.29%),对于冠状动脉和其分支的狭窄程度的低估占假阴性结果的66.67%(20/30),壁冠状动脉和心肌桥的漏诊占假阴性结果的23.33%(7/30)。结论64层螺旋CT诊断冠状动脉重度狭窄具有较高的准确性,钙化斑块、心肌桥和小血管的狭窄病变本身均影响CTA评价狭窄的准确性,而非钙化斑块和支架/冠状动脉旁路移植术(CABG)后狭窄的诊断准确性较高。
Objective To investigate the effect of coronary artery disease on CTA in assessing the accuracy of vascular stenosis. Materials and Methods CTA and CAG were performed in 60 patients with clinically suspected coronary artery stenosis in the same period. CTA scan using 64-slice spiral CT and retrospective ECG gating technology to CAG results as the gold standard, double-blind evaluation of the accuracy of CTA diagnosis of coronary artery stenosis and analyze the various factors of coronary artery disease on the evaluation of stenosis accurate Sexual effects. Results The sensitivity of CTA in the diagnosis of mild, moderate and severe coronary artery stenosis was 76.47%, 77.97% and 85.71%, respectively. Calcified plaques were the most important self-factors in assessing the false positive of coronary artery stenosis by 64-slice spiral CT (18/28, Accounting for 64.29%). The underestimation of the stenosis of the coronary artery and its branches accounted for 66.67% (20/30) of the false negative results, and the missed diagnosis of the wall coronary artery and myocardial bridge accounted for 23.33% (7/30) of the false negative results. Conclusion 64-slice spiral CT has a high accuracy in diagnosis of severe coronary stenosis. The stenosis of calcified plaque, myocardial bridge and small vessel itself affects the accuracy of CTA in evaluating stenosis, but not calcified plaque and scaffold / coronary artery The diagnosis of stenosis after road grafting (CABG) is highly accurate.