| ObjectiveThrough analyze 316 cases of patients with coronary artery CTA,to investigate the application value of 256-slice CT angiography(CTA) for diagnosing coronary artery lesions;through analyze of 124 cases of normal physical examination left coronary artery bifurcation lesions,to discuss the potential relationship between bifurcation and plaques forming in the left coronary arteries.Methods316 patients suspected of coronary heart disease underwent 256-slice CTA examination,47 of whom underwent coronary angiography.The CAG results were regarded as "gold standard",the diagnosis capacity of CTA for detecting coronary artery stenosis were analyzed.According to the AHA for coronary artery segment method,it can be divided into 15 segments,to evaluate the image quality of each segment on a five-point scale;the distribution of each coronary artery plaque were recorded.Selected 124 cases healthy crowd(with no high cholesterol, no high blood pressure, and no diabetes), by measuring the left coronary artery bifurcation angle and analyzing the distribution of plaques,to study the potential relationship between them.Results(1)Among 316 patients,3550 segments were considered four and five score of 3753 segments shown with CTA examination(the evaluate rate is 94.59%).(2)Compared with the CAG results,the accuracy rate of 256-slice CTA in diagnosing coronary artery stenosis was91.41%,the sensitivity was 89.77%,and the specificity was 92.12%;The sensitivity rates of CTA for evaluating the different coronary artery stenosis were: slight stenosis(73.68%),moderate stenosis(80.43%), serious stenosis(87.67%);The accuracy of CTA in diagnosing the moderate and severe stenosis of coronary artery(stenosis in segments of coronary artery≥50%)was 95.88%,the sensitivity was 92.44%,and the specificity was 96.76%,in diagnosing coronary artery stenosis there was high consistency in the results of CTA and CAG,especially in the moderate and severe stenosis.(3)Among 3753 coronary artery segments,865 segments were unnormal,the distribution of the plaque in the coronary segments was asignificantly different(χ2=160.37,P<0.005).The largest number of plaques was in section 6(about 22.66%),the section 14 and 15 were at least(total 1.97%).Among all kinds of plaques,the largest number was the mixed plaque(about 39.08%),the second was the non-calcified plaque(35.03%),the least was the calcified plaque(25.90%).The degree of stenosis due to different types of plaque was obviously different(χ2=98.0045,P<0.005).Which elicited mild stenosis(or without obvious stenosis) was mainly for calcified plaque(about 35.48%),followed by non-calcified plaque(about 34.56%),caused moderate and severe stenosis was mainly for the mixed plaques(about 54.52%).(4)The results showed that,among 124 cases,the mean bifurcation angle(LAD-LCX) with plaques between LAD and LCX was measured(89.10±14.56),the mean bifurcation angle with normal was(77.45±15.08),there was obvious difference in the bifurcation angle between the two groups(P<0.05).Conclusion(1)The 256-slice CTA can display each segment of coronary artery clearly,also can show the lesions of coronary artery.(2)The CAG results were regarded as "gold standard",The accuracy and consistency was more higher of the 256-slice CTA in the diagnosis of CHD,it can be of great significance for diagnosis、therapy and screening of coronary heart disease.(3)The 256-slice CTA can accurately analyze the distribution and nature of coronary artery plaques,further analysis of the stability of the plaques, reduce the incidence of ACS.(4)By measuring the bifurcate angel of coronary artery we found that,the bifurcate angel has close correlation with the plaque:along with the rising of the bifurcation angle,the incidence rate of the plaque was also increased.So,as a noninvasive examination,the 256-slice CTA has important clinical value in diagnosis of CHD,and to offer more reliable information for the selection of treatment. |
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