The Study On The Diagnostic Value Of Multislice Spiral CT Coronary Angiography

Purpose：1.To study the value of MSCT coronary angiography in diagnosis ofcoronary heart disease(CHD).2.To discuss the value of MSCT coronary angiography in diagnosis of congenitalCoronary artery anomalies(CAAs).Materials and methods：1The value of MSCT coronary angiography in diagnosis of coronary heartdisease(CHD).1.1Clinical materialFrom January2009to January2013,125cases(82males and43females,agedfrom33to85years old) with suspected or confirmed coronary heart disease(CHD)were all detected by multi-slice spiral CT coronary angiography(MSCTCA) scanningand coronary angiography (CAG) examination in2weeks.1.2Main instrument and method1.2.1All patients were treated with CAG using digital subtraction angiography(DSA)machine made in SIEMENS Company.1.2.2All patients were treated with MSCT coronary angiography using64-slice volume CT made in PHILIPS Company. Heart scan mode and retrospectiveECG-gating were used. Different processes such as Volume rendering(VR)、Maximum intensity projection (MIP)、Multi-planar reconstruction (MPR)、Curvedplanar reconstruction (CPR) were used to assess images in Brilliance imageworkstation.1.2.3Data evaluationFifteen segments of coronary artery were analyzed in each patient，according tothe method which the American Heart Association （AHA）recommends.Coronary artery were divided into5groups according to the stenosisextent，normal、mild stenosis（less than50%）、moderate stenosis （50-75%）、severe stenosis（more than75%） and occlusion.Judge the nature of plaques according to the CT density of coronaryatherosclerotic plaque which the image shown，soft plaque（CT density <60HU）、fibrous plaques（CT density60~130HU）、calcified plaque（CT density≥130HU）、mixed plaques（including calcification composition and non-calcified components）.1.2.4Statistical analysisThe data were analyzed by statistical software SPSS17.0. The criterion forstatistical significance was p<0.05.The precision and accuracy of the diagnosis incoronary artery stenosis extent according to Kappa consistency test andsensitivity(Se),specificity(Sp),positive predictive value(PPV),negative predictivevalue (NPV)analysis.2the value of MSCT coronary angiography in diagnosis of congenital Coronaryartery anomalies(CAAs).2.1Clinical materialFrom January2009to January2013，2700cases with suspected or confirmedcoronary heart disease(CHD) were analyzed. These patients accept64MSCTCAscanning. Coronary artery anomalies in origin were detected in1.52%of the cases，24males and17females, age from27to91years old.2.2Main instrument and methodThe instrument and method were same as Part1． Results：1The value of MSCT coronary angiography in diagnosis of coronary heartdisease(CHD).1.1The image quality on Multi-slice spiral CT coronary angiography(MSCTCA)1725segments（92%） of125patients were able to evaluate.1.2The display of the coronary artery disease on multi-slice spiral CT coronaryangiography（MSCTCA） and coronary angiography(CAG)The results of vasculopathy on Multi-slice spiral CT coronary angiography(MSCTCA) is good agreement with that of coronary angiography（CAG）. Thecoincidence rate was93．0％（1604/1725）.1.3The diagnosis in coronary artery stenosis (more than50%) on Multi-slicespiral CT coronary angiography (MSCTCA) and coronary angiography（CAG）426segments （coronary artery stenosis more than50%)were detected onMulti-slice spiral CT coronary angiography (MSCTCA)，in accordance with thecoronary angiography（CAG）. The coincidence rate was88.75％（426/480）. TheSe，Sp，PPV，NPV and accuracy were86.11％，93．97％，88.75％，95.54％，86.59％．1.4The relationship between nature of plaque and extent of stenosis onMulti-slice spiral CT coronary artery (MSCTCA)The mixed plaque aways lead to severe stenosis，however，calcified plaquealways lead to mild stenosis．The distribution of stenosis caused by noncalcifiedplaque and calcified plaque was no specificity．The distribution of stenosis betweencalcified and noncalcified plaque or between calcified and mixed plaque hadsignificant difference.2the value of MSCT coronary angiography in diagnosis of congenital Coronaryartery anomalies(CAAs).2.1Classification according to the variation vessels2.1.1Both Left coronary artery（LCA）and Right coronary artery （RCA）are originfrom the left coronary sinus（n=1，2.44%）.2.1.2Left Coronary artery（LCA） anomalies（n=13，31.71%），of which the left circumflex coronary artery(LCX) anomalies（n=9）.2.1.3Right Coronary artery anomalies（n=27，65.85%）.2.2Classification according to the variation type2.2.1High coronary takeoff(n=5,12.20%)2.2.2Absence or dysplasia of coronary artery (n=3,7.32%)2.2.3Single origin of coronary artery(n=1,2.44%)2.2.4Separate origins of coronary artery（n=9,21.95%）.2.2.5Coronary arteries originate from the contralateral sinus of Valsalva or thecontralateral coronary arteries(n=23,56.10%).Right coronary arteries originate fromthe left sinus of Valsalva(n=18).Conclusions：1.Multi-slice spiral computed tomography （MSCTCA）is of high sensitivity（Se），specificity （Sp），negative predictive value （NPV） and accuracy in thediagnosis of coronary artery disease （stenosis extent more than50%）.It can judgethe nature of the atherosclerotic plaques,but still exist difficulties in the judgementof vulnerable plaques.2.Multi-slice spiral computed tomography （MSCTCA） is a accuratenoninvasive method in diagnosis of congenital coronary artery anomalies.It can Judgethe origins and direction of the coronary artery anomalies,and provide valuablereference for coronary angiography(CAG)、coronary artery stent implantation (PCI)and coronary artery bypass surgery (CABG).