| Background: Coronary Artery Disease is a serious threat to human life and health;it has a high morbidity and mortality.The World Health Organization(WHO)take it as a present one of three “killer” of human.As is well known,currently the Invasive Coronary Angiography(ICA)is still considered the “Gold Standard” to criteria the coronary artery stenosis degree and diagnose the coronary heart disease.But the ICA is an invasive examination and has a certain complications and expensive,and it is not suitable for screening of high-risk groups.The Dual-source computerized tomography(DSCT)was introduced by Siemens in 2005,which has very high time resolution and has been the first-line examination for CAD with noninvasive measurement and its high time resolution.But compared with the “gold standard” ICA,the sensitivity and specificity of DSCT-CA to diagnose the degree of coronary artery stenosis still has some differences.At the same time,combined with our clinical experience,there are still some problems that affect the imaging quality of DSCT-CA.Purpose: The purpose of this research is to analyze the factors which affect the accuracy of DSCT-CA to diagnose the degree of coronary artery stenosis,and how to relieve or avoid the influence of these factors.Thus to improve the diagnostic accuracy of DSCT-CA.Method: From April-2014 to December-2015,we selected 83 patients who were clinical suspected or diagnosis CHD to conduct DSCT-CA,all of them carried out the ICA within 1 month later.According to the American association(AHA),coronary artery was divided into 15 segments.The right coronary artery(RCA)is defined as including segments 1—4,the left main(LM)artery as segment 5,the left anterior descending artery(LAD)as segments 6—10,and left circumflex artery(LCX)as segments 11—15.Coronary artery stenosis degree is divided into 5 levels.(1)No narrow;(2)Light stenosis:the degree of coronary artery stenosis is less than 50%;(3)Moderate stenosis: the degree of coronary artery stenosis is more than 50% but less than75%;(4)Severe stenosis: the degree of coronary artery stenosis is more than 75%;(5)Totally blocking: the degree of coronary artery stenosis is 100%.Counting the segments which ICA and DSCT-CA regard for different level,and looking for the reasons.Results: 1.There were 1110 segments in 83 patients who underwent DSCT-CA and ICA were analyzed,the inconsistent segments were 61.There were 25 segments were overvalued and 36 segments were undervalued.Volume artifacts caused by severe calcified plaque was accounted for 10 segments(8 segments was overvalued and 2 segments was undervalued);The overvalued or undervalued of coronary artery stenosis because the non-calcified or mixed plaques was accounted for 17 segments(13 segments were misdiagnosis and 4 segments were overvalued);Heart rate variability was accounted for 8 segments(2 segments were overvalued and 6 segments were undervalued);Respiratory movement was accounted for 7 segments(2 segments were overvalued and 5 segments were undervalued);The influence of myocardial bridge was accounted for 4 segments(2 segments were overvalued and 2 segments were undervalued);The inappropriate position of measurement was accounted for 6segments(6 segments were all undervalued);The influence of contrast medium was accounted for 3 segments(1 segments was overvalued and 2 segments was undervalued).2.By X2 test,there is no statistically difference between DSCT-CA and ICA result in the extent of coronary stenosis <50%,?50% and ?75%.Conclusion: 1.A variety of factors have effect on the diagnosis accuracy of DSCT-CA.Having a good understanding of these factors can help us to improve the imaging quality and diagnosis accuracy.2.DSCT-CA is a reliable and safe method for the diagnosis of coronary artery stenosis. |
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