| Object: Comparing the image differences in the areas of the coronary lesions, plaques situation, blood flow between CAG and MSCT coronary image of patients during the same period, to evaluate the application value of MSCT in coronary heart disease and provide a theoretical basis for clinical .Materials and Methods: 115 patients with suspected or diagnosed coronary heart disease during January 2008 to April 2009, including 69 cases male and 46 cases femal with the average age of 66.3±5.8 years old, were choosed for research objects, in which the patients accompanied by the history of clear coronary stent implantation or bypass surgery, or the contraindications of CAG, MSCT coronary angiography, or suffering from acute myocardial infarction were excluded.All selected patients were treated with CAG using digital subtraction angiography machine produced in Shimadzu Company and coronary angiography utilizing 64-slice volume CT made in The U.S. General Electric Company, which interval of two checks was less than 2 weeks. Imaging results were assessed respectively by two longevity chief physicians in cardiovascular medicine and CT room via an independent double-blind method.Coronary artery tree was divided into 13 segments to analyze in accordance with the American Heart Association, using five grades CT image criteria Van Hoe et al developed. Coronary lesions were divided into five groups based on degree of coronary artery stenosis: normal group, mild lesions group, significant lesions group, a high degree of stenosis group and complete occlusion group. The nature of coronary atherosclerotic plagues to determine depent on the density differences between plaque and contrast agent in coronary. TIMI classification method was used to analyze the coronary blood flow. The data were analyzed by statistical software SPSS13.0. The criterion for statistical significance was p<0.05. Results: 1. CAG could display clearly anatomy of coronary main and secondary branches. The ratio of MSCT reconstruction image assessment in LM, LAD1, LAD2, RCA1, RCA3, and LCX3 was more than 90%, while that of MSCT in LAD3, LCX2 ,D, OM, PDA, and PLA was less or equal 80%;2. There were significant differences in diagnosis of different coronary lesion groups for MSCT (p <0.001), but its diagnosis results was highly consistent with CAG (K value of 0.902, p <0.001).3. The specificity and the negative predictive values for MSCT to assess≥50%,≥75% vessel stenosis were 98.2%, 97.7% and 98.0%, 98.2%, respectively.The sensitivity and the positive predictive value in detecting≥50% coronary stenosis for MSCT were 90.8%, 92.7%, while that of in assess≥75% coronary stenosis were 84.2%, 82.2%, separately.The sensitivity, the specificity, the positive predictive value and the negative predictive value for MSCT to identify the lesions of coronary artery such as LM, LAD1, LAD2, LCX1, RCA1, RCA2 and RCA3 were 91.4-100%.The sensitivity and the positive predictive value for MSCT to diagnose the stenosis of coronary artery such as LAD3,D,LCX2,OM,RCA3,PDA and PLA were 75-88.9%, in which the specificity and the negative predictive value 93.1-98.3%4. MSCT could clearly show the distribution of coronary atherosclerosis plaques and the formation of collateral blood vessel, but there are limitations on the display of blood flow. The accuracy of MSCT to display coronary stenosis caused by atherosclerosis plaques was better (K value 0f 0.782, p <0.001), in which that of caused by soft plaque (K value of 0.829, p <0.001) or fibrous plaques (Kvalue of 0.849, p <0.001) was better than calcified plaque (K value of 0.734, p <0.001). Conclusion: MSCT can be used as a noninvasive diagnosis method in detecting coronary heart disease, clearly showing the morphological changes of coronary artery common area. MSCT is of high clinical value in guiding the choice of clinical treatment of coronary revascularization, clearly displaying the situation of coronary artery atherosclerosis plaques and collateral formation.
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