第二代双源128层CT冠脉成像对冠脉搭桥术后桥血管通畅情况的评价

摘要

Objective To investigate the value of the second generation dual-source 128 slices CT coronary angiography (CTCA) in diagnosing patency of bypass after coronary artery bypass grafting. Methods66 patients who underwent coronary artery bypass grafting received CTCA on 128 slices dual-source CT. The raw data were reconstructed using volume rendering (VR), maximum intensity projection (MIP) and curved planar reformations (CPR). The results of the dual source CT coronary angiography were analyzed. The accuracy of the dual-source CT angiography in the assessment of grafts patency was determined with selective coronary angiography (CAG) as the reference standard in 19 patients.Results All of the 192 bypass grafts were successfully shown in 66 patients. Of 56 left internal mammary artery grafts and 3 radial artery grafts, there were 54 patent grafts (91.5%), 5 restenosis or occlusive grafts (8.5%). Of 133 saphenous vein grafts, 102 grafts (76.7%) were patent, 31 grafts (23.3%) showed restenosis or were occluded. The rate of patency of artery graft was statistically higher than that of vein graft (P<0.05). In contrast with CAG, the sensitivity, speciifcity, positive predictive value, negative predictive value, and accuracy were 93.75%, 94.29%, 88.24%, 97.06%, and 94.12% for the dual-source CT to identify restenosis and occlusion in bypass grafts. The two methods are highly consistent (Kappa=0.866). Conclusion The second generation dual-source 128 slices CTCA is an effective method for detecting the patency of bypass after coronary bypass grafting.%目的：探讨第二代双源128层CT冠状动脉成像对冠脉搭桥术后桥血管通畅情况的评估价值。方法对66例冠脉搭桥术后患者行双源128层CT冠状动脉成像，采用容积再现（VR）、最大密度投影（MIP）、曲面重建（CPR）等多种图像后处理技术重建图像，分析双源CT冠状动脉成像结果。其中19例同时行冠脉造影检查，以冠脉造影为金标准，评价双源CT冠状动脉成像对桥血管通畅情况的评估准确性。结果66例患者共检出桥血管192支，其中左乳内动脉桥56支，桡动脉桥3支，大隐静脉桥133支；动脉桥血管中通畅54支（91.5%），病变5支（8.5%）；静脉桥血管中通畅102支（76.7%），病变31支（23.3%）。静脉桥血管狭窄、闭塞的发生率明显高于动脉桥血管（P<0.05）；以冠脉造影为金标准，第二代双源CT冠状动脉成像评价桥血管病变的敏感性为93.75%，特异性为94.29%，阳性预测值为88.24%，阴性预测值为97.06%，准确性为94.12%，两种方法一致性较高（Kappa=0.866）。结论第二代双源128层CT冠状动脉成像对冠脉搭桥术后桥血管通畅情况有较高的评估价值。