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目的评价64层螺旋CT诊断冠状动脉支架内再狭窄(ISR)的临床价值。方法采用64层螺旋CT对14例冠状动脉支架置入术后的患者(共37个支架)进行CT冠状动脉成像(CTA)。在CTA上,通过肉眼观察和测量支架内CT值两种方法诊断ISR。以冠状动脉造影(ISR≥50%)为标准,计算并比较两种方法诊断ISR的准确性。结果37个支架中,CCA检出ISR(≥50%)11个,正常(包括ISR＜50%)26个。与CCA对照,CTA肉眼观察法正确诊断ISR 2个,正常18个,CT值测量法则分别正确诊断ISR 3个,正常21个。两种方法诊断ISR的敏感性、特异性、阳性预测值和阴性预测值分别为18%、69%、20%、67%和27%、81%、38%、72%。两种方法各项准确性指标之间差异均无统计学意义(P＞0．05)。结论64层螺旋CT诊断ISR十分困难,但对排除ISR有一定的作用。
Objective To evaluate the clinical value of 64-slice spiral CT in the diagnosis of coronary stent restenosis (ISR). Methods CT coronary angiography (CTA) was performed in 14 patients with coronary stenting (37 stents) using 64-slice spiral CT. On CTA, ISR is diagnosed by visual inspection and measurement of intra-stent CT values. To coronary angiography (ISR ≥ 50%) as the standard, calculated and compared two methods to diagnose the accuracy of ISR. Results Of 37 scaffolds, 11 were detected by CCA (≥50%) and 26 were normal (including ISR <50%). Compared with CCA, CTA macroscopic diagnosis correctly diagnosed 2 ISRs and 18 normal ones. The CT value measurement method correctly diagnosed 3 ISRs and 21 normals respectively. The sensitivity, specificity, positive predictive value and negative predictive value of the two methods were 18%, 69%, 20%, 67% and 27%, 81%, 38% and 72%, respectively. There was no significant difference between the accuracy of the two methods (P> 0.05). Conclusion 64-slice spiral CT is very difficult to diagnose ISR, but it has a certain effect on excluding ISR.