| Purpose: Coronary heart disease(CHD)seriously harms human health.Selective coronary angio-graphy(CAG)remains gold standard to diagnosis of CHD so far.however, the invasive procedure is costly and dangerously, what's more, accord ing to the literature report, there was one millin people underwent CAG every year, Approximately72% of all are dong to excludesignificant stenosis of Coronary artery and not followed by percutaneous coronary inter-Vention(PCI).So an alternative non-invasive Technique to evaluate coronary arterial stenosis severity would be of great benefit.recently with the technical development and significantly improved image quality, multi-slice spiral computed tomography(MSCT), as a Kind of non-invasive technique, plays a potential role in diagnosis of the patients with CHD.It is more easily accepted by people Than the invasive CAG. Our objective is to evaluate coronary plaque characteristic using 64-slice spiral computed tomography (CT) angiography in patients with coronary heart disease (CHD)confirmed by coronary angiography. To investigate the reliability of 64-slice CT in the diagnosis of coronary plaque instability and clinical significance.Methods: 136 patients with CHD were confirmedby coronary angiography(CAG) and dividedinto SA (stable angina ) (n=72) and UA (unstable angina) (n=64) groups based on clinical feature. All the patients underwent64-slice spiral CT coronary angiography todetect the stenosis degree and atherosclerosis plaque character in main coronary artery. CT density of plaque was expressed as Hounsfield Unit(HU). According to the coronary artery stenosis diameter ratio, the groups were divided into:25～50%for mild, 51～75% moderate, and high rates of more than 76%. And the plaque character was differentiated according to the following criteria:CT value<60HU was soft plaque;CT value 60～129HU was intermediate plaque;CT value>130HU was calcified plaque;a plaque with two or more components above was defined as mixed plaque.In accordance with the result of CAG, the diagnosis accuracy of MDCT coronary angiography was evaluated and the stenosis degree of different plaque was observed.Results: Among the 1768 coronary arteries segments of over 2mm diameter in 136 patients, 1216(68.8%)were evalurable by 64-slice spiral computed tomography. Except the unevalurable Coronary artery segments, All the segments compared with CAG, The sensitivity, specificity, Positive and negative predictive value was 89.8%, 97.2%, 83.8% and 98.3% respectiveiy.64-slice spiral computed tomography can assess atherosclerotic plaque morphology and composition. 338 plaques were detected by 64MSCT, the number of plaques did not differ between two groups, Coronary angiography showed no significant differences in the diseased artery and the degree of stenosis between the two groups. 64MSCT revealed that there were significantly more soft lesions in group UA than in Group SA, and that fibrous and calcific lesions were more prevalent in Group SA(p<0.01).In UAgroup , mild stenosis with soft plaque lesions was accounted in 49%, and only 17% of the lesions had severe stenosis;50% of mixed plaque lesions had severe stenosis in UAgroup. Different types of plaque in the comparison between the degree of stenosis were statistically significant.Conclusions:64MSCT coronary angiography can be used in the quantittive diagnosis of coronary artery stenosis and plaque with a higher accuracy rate.Clear patch form, location and length of the relationship between the branches of coronary plaque also can be evaluated.64MSCT can by measuring CT value of different plaque composition to separate patches into soft plaque, calcified plaque, and mixed plaque.64MSCT can described the composition of coronary atherosclerosis for qualitative evaluation of the stability of plaque and timely identification of vulnerable plaque for intervention treatment.Compare to mild stenosis with soft plaque lesions, the more severe stenosis had mixed plaque lesions, the more severe stenosis had mixed plaque lesions. |
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