| With the development of social civilization and people’s lifestyle changes,coronary heart disease has become one of the harmfulness human disease and aglobal public health problem. Therefore early diagnosis and early prevention ofcoronary artery disease has become the primary task in our clinical work.Coronary angiography (Coronary angiography, CAG) has been always the"golden standard" of the diagnosis of coronary heart disease. But recently, alarge number of studies have found that the CAG check of the patients whosecoronary artery without significant stenosis can also occur acute coronary events,and the autopsy results found that the patients had significant arteryatherosclerotic plaque. Intravascular ultrasound (intravascular ultrasound, IVUS)can observe the vascular wall and atherosclerotic plaque directly, and canaccurately determine the nature of the plaque. Therefore, IVUS has beenconsidered as the real "golden standard" of evaluating plaque nature in coronary heart disease. However, the CAG and the IVUS are invasive operation and theIUVS examination is expensive and difficult to use in clinical widely. Thedual-source CT coronary angiography (Dual-Source Computed TomographyAngiography, DSCTA) is a new noninvasive examination, with high temporaland density resolution. It can not only show coronary stenosis levels anddistinguish wall plaque characteristics but also has high tolerance for high heartrate patients. It has wide application prospects. In this study, patients whosuspected with coronary heart disease received DSCTA, CAGexaminationrespectively. The DSCTA, CAG,results comparative analysis in coronary heartdisease examination were discussed. We tried to explore the clinical value ofDSCTA in diagnosis and treatment follow-up of coronary artery disease.Aims1. Patients who suspected with coronary heart disease received DSCTA,CAGexamination respectively. The DSCTA, CAG results comparative analysisin coronary heart disease examination were discussed. The diagnostic accuracyof DSCTA in coronary atherosclerotic plaque and stenosis degree were studied.We tried to explore the diagnostic and therapeutic value of DSCTA in coronaryatherosclerosis diseases.2. The patients who reviewed after PCI suspected lumen re-stenosisreceived the DSCTA, CAG and the IVUS examinations respectively as areference to the IVUS results. The diagnostic accuracy of DSCTA in patientswho had restenosis after received artery PCI operation was studied. And theresults were compared with IVUS in same patients. We tried to explore theclinical application in coronary heart disease.Methods1.15cases of patients who were suspected having coronary artery diseasewere collected during March2009-December2010. All the examination results of DSCTA、 CAG and CMRA were included.①The stenosis degree ofdiagnostic accuracy between the DSCTA and the CAG, the CMRA and the CAGwere comparatively evaluated with the IVUS and the CAG’s results as areference;②The diagnostic performance of DSCTA and CMRA was evaluatedwith the CAG’s results as the golden standard for evaluation;③The DSCTA’sdiagnostic accuracy evaluation of the lesion plaque composition was performedwith the IVUS as the golden standard.2.15cases of patients who were suspected having lumen restenosis AfterPCI opration were collected during January2010-December2011. All theexamination results of DSCTA、CAG、IVUS were included. We compared thediagnostic accuracy of DSCTA in the lumen stenosis patients with IVUS.Results1.15patients,60coronary,57measurement locations involved in thestatistical analysis.①As the degree of stenosis of coronary artery disease, DSCTA determinedthe correct53,4lenient sentence,0heavy sentence; the CMRA judged correctly52,5lenient sentence,0heavy sentence with the CAG as the standard.②Thediagnostic accuracy rates of>50%coronary stenosis of the CMRA, DSCTA wasabove90%with the CAG as the golden standard.③There was no statisticallysignificant difference between DSCTA and IVUS in identifying coronary plaquecomposition (k=0.759P>0.75). The diagnostic accuracy of DSCTA of calcifiedplaque was higher than that of non-calcified plaque. The four methods resultswere treated with validity evaluation, there was no statistical significantdifference.2. The15patients who had in-stent restenosis <50%were diagnosed withDSCT, CAG and IVUS. The results showed that the positive cases of coronaryin-stent restenosis>50%were5/10,2/13,4/11respectively. There was no significant difference (P>0.05) between three groups.Conclusions1. DSCTA can clearly display the diameter>2mm coronary and canaccurately determine the degree of stenosis, especially have high sensitivity andspecificity for diagnosis of normal coronary artery and severe stenosis.Therefore, it is a good way of non-invasive diagnosis method of CAD. TheDSCTA has high time resolution. It can display and measure the plaque moreaccurately. And it has higher detection rate of wall calcification or non-calcifiedplaque and can determine the nature of plaque. Thus DSCTA can be used as anoninvasive, easy-to-screening method for diagnosis of coronary artery diseaseand the preferred method of screening high-risk groups.2. DSCTA was able toaccurately assess the restenosis after PCI operation, and has the same resultswith the IVUS. DSCTA could be the preferred method of reexamination for thepatients who had received the PCI operation.2. DSCTA can safely and noninvasively showed the stent position, length,with or without thrombosis and intimal thickening and can accurately assess thepost-PCI restenosis. And it is a good follow-up tool to exclude in-stentrestenosis with no significant difference to the IVUS results. But its imagequality can be affected by a variety of factors such as the stent itself and luminalrestenosis plaque cover which lead to overestimation of restenosis of the stentlumen. |
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