64排螺旋CT对冠心病血运重建术后支架及桥血管通畅性的诊断价值研究
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摘要
第一部分:64排螺旋CT判断冠脉支架通畅性的临床运用
目的:通过64排螺旋CT和常规冠脉造影影像资料对照研究,评价64排螺旋CT对冠脉支架的显示能力及其影响因素,并判断64排螺旋CT诊断支架内再狭窄的准确性。
材料和方法:67例冠脉支架置入术后患者(男性52例,女性15例,共124枚支架)先后经64排螺旋CT冠脉成像和常规冠脉造影检查,两项检查间隔时间小于3月。以常规冠脉造影为金标准,支架内再狭窄定义为支架腔狭窄程度和临近正常参照段相比≥50%,两位医师于CT上独立评价支架腔的显示情况以及有无再狭窄的发生,并进行敏感性、特异性的统计,同时就两位观察者间一致性进行检验,对金属裸支架和药物洗脱支架、不同类型药物洗脱支架内再狭窄发生率进行比较,并测量可评价支架内及支架两端血管CT值,拟合ROC曲线。
结果:124枚支架于CT上合计为110枚(重叠支架计算为1枚,即共有14枚重叠支架,非重叠支架96枚),其中105枚(94.5%)支架64排螺旋CT可评价。105枚可评价支架中,64排螺旋CT正确检出15例再狭窄病例和3例闭塞病例,但有6例假阳性,经统计其敏感性72%(18/25),特异性93%(74/80),阳性预测值75%(18/24),阴性预测值91%(74/81),准确性88%(92/105)。金属裸支架内膜增生发生率较药物洗脱支架高,而不同类型药物洗脱支架内膜增生发生率无统计学差异。内膜增生支架内CT值明显较通畅支架内CT值低,支架内CT值拟合的ROC曲线下面积为0.720,判断内膜增生的CT阈值设为442.1HU时,其敏感性为72%,特异性为62%。
结论:
1.经过选择的冠脉支架术后患者,64排螺旋CT可以较好的判断支架腔的再狭窄情况,可常规用于冠脉支架置入术后病人的随访;
2.定量测量CT值判断支架内再狭窄的准确性不如定性判断,仅可辅助诊断。
第二部分:64排螺旋CT对冠脉旁路血管移植术后桥血管的显示研究
目的:通过64排螺旋CT和常规冠脉造影的图像资料对照,探讨64排螺旋CT对冠脉旁路血管移植(冠脉搭桥)术后桥血管的显示情况,评价其判断桥血管通畅性的准确性。
材料和方法:46例患者(男性41例,女性5例,83支桥血管)先后经历64排螺旋CT冠脉成像和常规冠脉造影检查,两项检查间隔时间小于3月。以常规造影作为金标准,桥血管狭窄定义为管腔狭窄程度和临近正常参照段相比≥50%,两位医师于CT上独立评价桥血管的显示情况以及有无狭窄或闭塞,并分别对动脉桥和静脉桥血管进行敏感性、特异性、阳性预测值、阴性预测值及准确性的统计。同时就两位观察者间一致性进行检验。
结果:在总共83支桥血管中,64排螺旋CT可评价82(98.8%)支桥血管,不可评价的1支桥血管为左内乳动脉。40支可评价动脉桥血管中,64排螺旋CT正确检出1例狭窄病例和4例闭塞病例,无假阳性及假阴性,经统计其敏感性100%(5/5),特异性100%(35/35),阳性预测值100%(5/5),阴性预测值100%(35/35),准确性100%(40/40)。42支静脉桥血管中,64排螺旋CT正确检出6例狭窄病例和8例闭塞病例,有1例假阴性,统计得到其敏感性93%(14/15),特异性100%(27/27),阳性预测值100%(14/14),阴性预测值96%(27/28),准确性98%(41/42)。Kappa分析示两位观察者间具有较好的一致性(κ=0.89)。
结论:64排螺旋CT对冠脉搭桥术后患者桥血管显示通畅率诊断准确性和可靠性高,可作为了解桥血管通畅度的首选常规无创性影像诊断技术。
Objective:By comparing the images between 64-slice multidetector computed tomography(MDCT) and selective coronary angiography,we expect to evaluate the visualization of coronary stents and its affecting factors,as well as to assess the diagnostic accuracy of 64-slice MDCT on coronary in-stent restenosis(ISR).
Material and Methods:The study population consisted of 124 stents implanted in native coronary arteries in 67 consecutive patients(52 men,15 women) who underwent quantitive selective coronary angiography(QCA) preceded by 64-slice MDCT performed within 3 months period before QCA.With QCA as golden reference standard,ISR defined as percent diameter stenosis≥50%,two experienced observers evaluated the image quality and ISR analysis independently.Sensitivity, specificity,negative predictive value(NPV),and diagnostic accuracy of 64-slice MDCT are calculated,as well as the Kappa test between two observers.We compared ISR occurance between bare metallic stents(BMS) and drug eluting stents(DES),and also among different DESs.We also measured CT values in and peri assessable stent on 64-slice MDCT and draw the ROC curve.
Results:Of 110 stents counted on CT(with overlapped stents counted as one,a total of 14 overlapped and 96 single stents),105(94.5%) were considered assessable. Among the 105 stented segments,64-slice MDCT correctly detected 15 in-stent restenosis and 3 in-stent occlusions.Yet 6 were false-positive.Sensitivity,specificity, positive predictive value,negative predictive value,and diagnostic accuracy were 72%(18/25),93%(74/8),75%(18/24),91%(74/81),and 88%(92/105).The ISR incidence of BMS was higher than that of DES,and there's no statistical difference among various types of DES.The CT values in hyperplastic stents were significantly lower than those patent stents.The ROC curve drawn from overall CT values in stents showed the area below the curve as 0.720.When the CT threshold value of ISR was 442.1HU,the sensivity and specificity of 64-slice MDCT of detecting significant ISR was 72 and 62%respectively.
Conclusions:
1.For selected patients with previous stent implantation,64-slice MDCT can be used to evaluate in-stent restenosis with high accuracy,which can be regular application of the follow-up of post PCI patients.
2.Quantitative analysis by measuring CT values was less accurate than qualitative analysis,and can thus only be used as assistant method.
Objectives:Comparing the images of 64-slice MDCT and selective coronary angiography,we discussed the ability of 64-slice MDCT imaging of coronary artery bypass grafts,and evaluated its diagnostic accuracy.
Materials and Methods:46 patients(41 men,5 women) after bypass surgery with a total of 83 bypass grafts have underwent selective coronary angiography preceded by 64-slice MDCT performed within 3 months period before coronary angiography. With coronary angiography as golden reference standard,bypass grafts stenosis was defined as percent diameter stenosis≥50%.Two experienced observers evaluated the image quality and bypass grafts stenosis independently.Sensitivity,specificity, negative predictive value(NPV),and diagnostic accuracy of 64-slice MDCT are calculated,as well as the Kappa test between two observers.
Results:Of 83 bypass grafts,82(98.8%) were considered assessable on 64-slice MDCT images.The only unassessable bypass graft was left internal mammary artery. Of 40 arterial bypass grafts,64-slice MDCT correctly detected 1 stenosis and 4 occlusions without false positive or false negative cases.Sensitivity,specificity, positive predictive value,negative predictive value,and diagnostic of 64-slice MDCT evaluating arterial bypass grafts were 100%(5/5),100%(35/35),100%(5/5),100% (35/35),and 100%(40/40) respectively.Of the rest 42 saphenous vein bypass grafts,6 stenosis and 8 occlusions were correctly detected by 64-slice MDCT.But there was one false negative case.Sensitivity,specificity,positive predictive value,negative predictive value,and diagnostic accuracy of 64-slice MDCT to detect signicant stenosis of saphenous vein bypass grafts were 93%(14/15),100%(27/27), 100%(14/14),96%(27/28),and 98%(41/42) respectively.Kappa analysis showed excellent interobserver agreement(k=0.89).
Conclusions:For selected patients who have underwent coronary artery bypass grafts surgery,64-slice MDCT had high diagnostic accuracy and reliability,and can be the priority of regular non-invasive diagnostic technologies to evaluate the patency of bypass grafts.
目的:通过64排螺旋CT和常规冠脉造影影像资料对照研究,评价64排螺旋CT对冠脉支架的显示能力及其影响因素,并判断64排螺旋CT诊断支架内再狭窄的准确性。
材料和方法:67例冠脉支架置入术后患者(男性52例,女性15例,共124枚支架)先后经64排螺旋CT冠脉成像和常规冠脉造影检查,两项检查间隔时间小于3月。以常规冠脉造影为金标准,支架内再狭窄定义为支架腔狭窄程度和临近正常参照段相比≥50%,两位医师于CT上独立评价支架腔的显示情况以及有无再狭窄的发生,并进行敏感性、特异性的统计,同时就两位观察者间一致性进行检验,对金属裸支架和药物洗脱支架、不同类型药物洗脱支架内再狭窄发生率进行比较,并测量可评价支架内及支架两端血管CT值,拟合ROC曲线。
结果:124枚支架于CT上合计为110枚(重叠支架计算为1枚,即共有14枚重叠支架,非重叠支架96枚),其中105枚(94.5%)支架64排螺旋CT可评价。105枚可评价支架中,64排螺旋CT正确检出15例再狭窄病例和3例闭塞病例,但有6例假阳性,经统计其敏感性72%(18/25),特异性93%(74/80),阳性预测值75%(18/24),阴性预测值91%(74/81),准确性88%(92/105)。金属裸支架内膜增生发生率较药物洗脱支架高,而不同类型药物洗脱支架内膜增生发生率无统计学差异。内膜增生支架内CT值明显较通畅支架内CT值低,支架内CT值拟合的ROC曲线下面积为0.720,判断内膜增生的CT阈值设为442.1HU时,其敏感性为72%,特异性为62%。
结论:
1.经过选择的冠脉支架术后患者,64排螺旋CT可以较好的判断支架腔的再狭窄情况,可常规用于冠脉支架置入术后病人的随访;
2.定量测量CT值判断支架内再狭窄的准确性不如定性判断,仅可辅助诊断。
第二部分:64排螺旋CT对冠脉旁路血管移植术后桥血管的显示研究
目的:通过64排螺旋CT和常规冠脉造影的图像资料对照,探讨64排螺旋CT对冠脉旁路血管移植(冠脉搭桥)术后桥血管的显示情况,评价其判断桥血管通畅性的准确性。
材料和方法:46例患者(男性41例,女性5例,83支桥血管)先后经历64排螺旋CT冠脉成像和常规冠脉造影检查,两项检查间隔时间小于3月。以常规造影作为金标准,桥血管狭窄定义为管腔狭窄程度和临近正常参照段相比≥50%,两位医师于CT上独立评价桥血管的显示情况以及有无狭窄或闭塞,并分别对动脉桥和静脉桥血管进行敏感性、特异性、阳性预测值、阴性预测值及准确性的统计。同时就两位观察者间一致性进行检验。
结果:在总共83支桥血管中,64排螺旋CT可评价82(98.8%)支桥血管,不可评价的1支桥血管为左内乳动脉。40支可评价动脉桥血管中,64排螺旋CT正确检出1例狭窄病例和4例闭塞病例,无假阳性及假阴性,经统计其敏感性100%(5/5),特异性100%(35/35),阳性预测值100%(5/5),阴性预测值100%(35/35),准确性100%(40/40)。42支静脉桥血管中,64排螺旋CT正确检出6例狭窄病例和8例闭塞病例,有1例假阴性,统计得到其敏感性93%(14/15),特异性100%(27/27),阳性预测值100%(14/14),阴性预测值96%(27/28),准确性98%(41/42)。Kappa分析示两位观察者间具有较好的一致性(κ=0.89)。
结论:64排螺旋CT对冠脉搭桥术后患者桥血管显示通畅率诊断准确性和可靠性高,可作为了解桥血管通畅度的首选常规无创性影像诊断技术。
Objective:By comparing the images between 64-slice multidetector computed tomography(MDCT) and selective coronary angiography,we expect to evaluate the visualization of coronary stents and its affecting factors,as well as to assess the diagnostic accuracy of 64-slice MDCT on coronary in-stent restenosis(ISR).
Material and Methods:The study population consisted of 124 stents implanted in native coronary arteries in 67 consecutive patients(52 men,15 women) who underwent quantitive selective coronary angiography(QCA) preceded by 64-slice MDCT performed within 3 months period before QCA.With QCA as golden reference standard,ISR defined as percent diameter stenosis≥50%,two experienced observers evaluated the image quality and ISR analysis independently.Sensitivity, specificity,negative predictive value(NPV),and diagnostic accuracy of 64-slice MDCT are calculated,as well as the Kappa test between two observers.We compared ISR occurance between bare metallic stents(BMS) and drug eluting stents(DES),and also among different DESs.We also measured CT values in and peri assessable stent on 64-slice MDCT and draw the ROC curve.
Results:Of 110 stents counted on CT(with overlapped stents counted as one,a total of 14 overlapped and 96 single stents),105(94.5%) were considered assessable. Among the 105 stented segments,64-slice MDCT correctly detected 15 in-stent restenosis and 3 in-stent occlusions.Yet 6 were false-positive.Sensitivity,specificity, positive predictive value,negative predictive value,and diagnostic accuracy were 72%(18/25),93%(74/8),75%(18/24),91%(74/81),and 88%(92/105).The ISR incidence of BMS was higher than that of DES,and there's no statistical difference among various types of DES.The CT values in hyperplastic stents were significantly lower than those patent stents.The ROC curve drawn from overall CT values in stents showed the area below the curve as 0.720.When the CT threshold value of ISR was 442.1HU,the sensivity and specificity of 64-slice MDCT of detecting significant ISR was 72 and 62%respectively.
Conclusions:
1.For selected patients with previous stent implantation,64-slice MDCT can be used to evaluate in-stent restenosis with high accuracy,which can be regular application of the follow-up of post PCI patients.
2.Quantitative analysis by measuring CT values was less accurate than qualitative analysis,and can thus only be used as assistant method.
Objectives:Comparing the images of 64-slice MDCT and selective coronary angiography,we discussed the ability of 64-slice MDCT imaging of coronary artery bypass grafts,and evaluated its diagnostic accuracy.
Materials and Methods:46 patients(41 men,5 women) after bypass surgery with a total of 83 bypass grafts have underwent selective coronary angiography preceded by 64-slice MDCT performed within 3 months period before coronary angiography. With coronary angiography as golden reference standard,bypass grafts stenosis was defined as percent diameter stenosis≥50%.Two experienced observers evaluated the image quality and bypass grafts stenosis independently.Sensitivity,specificity, negative predictive value(NPV),and diagnostic accuracy of 64-slice MDCT are calculated,as well as the Kappa test between two observers.
Results:Of 83 bypass grafts,82(98.8%) were considered assessable on 64-slice MDCT images.The only unassessable bypass graft was left internal mammary artery. Of 40 arterial bypass grafts,64-slice MDCT correctly detected 1 stenosis and 4 occlusions without false positive or false negative cases.Sensitivity,specificity, positive predictive value,negative predictive value,and diagnostic of 64-slice MDCT evaluating arterial bypass grafts were 100%(5/5),100%(35/35),100%(5/5),100% (35/35),and 100%(40/40) respectively.Of the rest 42 saphenous vein bypass grafts,6 stenosis and 8 occlusions were correctly detected by 64-slice MDCT.But there was one false negative case.Sensitivity,specificity,positive predictive value,negative predictive value,and diagnostic accuracy of 64-slice MDCT to detect signicant stenosis of saphenous vein bypass grafts were 93%(14/15),100%(27/27), 100%(14/14),96%(27/28),and 98%(41/42) respectively.Kappa analysis showed excellent interobserver agreement(k=0.89).
Conclusions:For selected patients who have underwent coronary artery bypass grafts surgery,64-slice MDCT had high diagnostic accuracy and reliability,and can be the priority of regular non-invasive diagnostic technologies to evaluate the patency of bypass grafts.
引文
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[30]Leschka S,Alkadhi H,Plass A,et al.Accuracy of MSCT coronary angiography with 64-slice technology:first experience[J].Eur Heart J,2005,26:1482-1487.
[31]Nieman K,Rensing BJ,van Geuns RJ,et al.Non-invasive coronary angiography with multislice spiral computed tomography:impact of heart rate[J].Heart,2002,88:470-474.
[32]Raff GL,Gallagher MJ,O'Neil,et al.Diagnostic accuracy of noninvasive coronary angiography using 64-slice spiral computed tomography[J].Am J Coll Cardiol,2005,46:552-557.
[33]Husmann L,Alkadhi H,BoehmT,etal.Influence of cardiac hemodynamic parameters on coronary artery opacificaion with 64-slice computed tomography [J].Eur Radiol,2006,16:1111-1116.
[34]Hecht HS,Zaric M,Jelnin V,et al.Usefulness of 64-detector computed tomography angiography for diagnosing in-stent restenosis in native coronary arteries[J].Am J Cardiol,2008,101:820-824.
[35]Morin RL,Gerber TC,McCollough CH.Radiation dose in computed tomography of the heart[J].Circulation,2003,107:917-922.
[36]Ketelsen D,Thomas C,Werner M,etal.Dual-source computed tomography:Estimation of radiation exposure of ECG-gated and ECG-triggered coronary angiography[J].Eur J Radiol,2008,doi:10.1016/j.ejrad.2008.10.033.
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[2]Hamm CW,Reimers J,IschingerT,etal.A randomized study of coronary angioplasty compared with bypass surgery in patients with symptomatic multivessel coronary disease[J].N Engl J Med 1994,331:1037-1043.
[3]Goldman S,Sadina K,Moritz T,et al.Long-term patency of saphenous vein and left internal mammary artery grafts after coronary artery bypass surgery:results from a Department of Veterans Affairs Cooperative Study[J].Am J Coll Cardiol,2004,44:2149-2156.
[4]Ropers D,Ulzheimers S,Wenkel E,et al.Investigation of aortocoronary artery bypass grafts by multislice spiral computed cosmography with electrocardiographic-gated image reconstruction[J].Am J Cardiol,2001,88:792-795.
[5]Anders K,Baum U,Schmid Michael,et al.Coronary artery bypass graft(CABG)patency:Assessment with high-resolution submillimeter 16-slice multidetector-row computed tomography(MDCT)versus coronary angiography[J].Eur Radiol,2006,57:336-344.
[6]Schlosser T,Konorza T,Hunold P,et al.Noninvasive visualization of coronary artery bypass grafts using 16-detector row computed tomography[J].Am J Coll Cardiol,2004,44,1224-1229.
[7]Chiurlia E,Menozzi M,Ratti C,et al.Follow-up of coronary artery bypass graft patency by multislice computed tomography[J].Am J Cardiol,2005,95:1094-1097.
[8]Martuscelli E,Romagnoli A,D'Eliseo A,et al.Evaluation of venous and arterial conduit patency by 16-slice spiral computed tomography[J].Circulation,2004,110:3234-3238.
[9]Ropers D,Pohle FK,Kuettner A,et al.Diagnostic accuracy of noninvasive coronary angiography in patients after bypass surgery using 64-slice spiral computed tomography with 330-ms antry rotation[J].Circulation,2006,114,2334-2341.
[10]Pache G,Saueressig U,Frydrychowicz A,et al.Initial experience with 64-slice cardiac CT:non-invasive visualization of coronary artery bypass grafts[J].Eur Heart J,2006,27:976-980.
[11]Onuma Y,Tanabe K,Chihara R,et al.Evaluation of coronary artery bypass grafts and native coronary arteries using 64-slice multidetector computed tomography[J].Am J Heart,2007,154:519-526.
[12]Andreini D,Pontone G,Ballerini G,et al.Bypass graft and native postanastomotic coronary artery patency:Assessment with computed tomography [J].Ann ThoracSurg,2007,83:1672-1678.
[13]Oncel D,Oncel G,Tastan A,et al.Evaluation of coronary bypass graft occlusion and stenosis with 64-detector-row computed tomography angiography[J].Acta Radiol,2007,48:988-996.
[14]Malagutti P,Nieman K,Meijboom WB,et al.Use of 64-slice CT in symptomatic patients after coronary bypass surgery:evaluation of grafts and coronary arteries
[J].Eur Heart J,2007,28:1879-1885.
[15]Jabara R,Chronos N,Klein L,et al.Comparison of multidetector 64-slice computed tomographic angiography to coronary angiography to assess the patency of coronary artery bypass grafts[J].Am J Cardiol,2007,99,1529-1534.
[16]Meyer TS,Martinoff S,Hadamitzky M,et al.Improved noninvasive assessment of coronary artery bypass grafts with 64-slice computed tomographic angiography in an unselected patient population[J].Am J Coll Cardiol,2007,49:946-950.
[17]Nazeri I,Shahabi P,Tehrai M,et al.Assessment of patients after coronary artery bypass grafting using 64-slice computed tomography[J].Am J Cardiol,2009,103:667-673.
[18]Garrett HE,Dennis EW,DeBakey ME.Aortocoronary bypass with saphenous vein graft.Seven-year follow-up[J].JAMA,1973,223:792-794.
[19]Debiolles L,Leschka S,Plass A,et al.Evaluation of temporal windows for coronary artery bypass graft imaging with 64-slice CT[J].Eur Radiol,2007,17:2819-2828.
[20]Einstein A J,Henzlova M J,Rajagopalan S.Estimating risk of cancer associated with radiation exposure from 64-slice computed tomography coronary angiography [J].JAMA,2007,298:317-323.
[1]Lowe HC,Oesterle SN,Khachigian LM.Coronary in-stent restenosis:current status and future strategies[J].Am J Coll Cardiol,2002,39:183-193.
[2]Serruys PW,de Jaegere P,Kiemeneij F,et al.A comparison of balloon-expandable-stent implantation with balloon angioplasty in patients with coronary artery disease[J].Benestent Study Group.N Engl J Med,1994,331:489-495.
[3]Fischman DL,Leon MB,Balm DS,et al.A randomized comparison of coronary-stent placement and balloon angioplasty in the treatment of coronary artery disease[J].N Engl J Med,1994,331::496-501.
[4]Holmes Jr DR,Leon MB,Moses JW,et al.Analysis of 1-year clinical outcomes in the SIRIUS trial:a randomized trial of a sirolimus-eluting stent versus a standard stent in patients at high risk for coronary restenosis[J].Circulation,2004,109:634-640.
[5]Morice MC,Colombo A,Meire B,et al.Sirolimus-vs paclitaxel-eluting stents in de novo coronary artery lesions:the REALITY trial:a randomized controlled trial [J].JAMA,2006,295:895-904.
[6]Fine JJ,Hopkins CB,Ruff N,et al.Comparison of accuracy of 64-slice cardiovascular computed tomography with coronary angiography in patients with suspected coronary artery disease[J].Am J Cardiol,2006,97:173-174.
[7]Miller JM,Rochitte CE,Deway M,et al.Diagnostic Performance of Coronary Angiography by 64-Row CT.N Engl J Med,2008,359:2324-2336.
[8]Hamon M,Champ-Rigot L,Morello R,et al.Diagnostic accuracy of in-stent coronary restenosis detection with multislice spiral computed tomography:a meta-analysis[J].EurRadiol,2006,18:217-225.
[9]Rixe J,Achenbach S,Ropers D,et al.Assessment of coronary artery stent restenosis by 64-slice multi-detector computed tomography[J].Eur Heart J,2006,27:2567-2572.
[10]Rist C,von Seigler F,Nikolaou K,et al.Assessment of coronary artery stent patency and restenosis using 64-slice computed tomography[J].Acad Radiol,2006,13:1465-1473.
[11]Das KM,EI-Menyar AA,Salam AM,et al.Contrast-enhanced 64-section coronary multidetector CT angiography versus conventional coronary angiography for stent assessment[J].Radiology,2007,245:424-432.
[12]Schuijf JD,Pundziute G,Jukema JW,et al.Evaluation of patients with previous coronary stents implantation with 64-section CT[J].Radiology,2007,245:416-423.
[13]Ehara M,Kawai M,Surmely JF,et al.Diagnostic accuracy of coronary in-stent restenosis using 64-slice computed tomography[J].Am J Coil Cardiol,2007,49:951-959.
[14]Cademartiri F,Schuijf JD,Pugliese F,et al.Usefulness of 64-slice multislice computed tomography coronary angiography to assess in-stent restenosis[J].Am J Coll Cardiol,207,49:2204-2210.
[15]Oncel D,Oncel G,Karaca M.Coronary stent patency and in-stent restenosis:determination with 64-section multidetector CT coronary angiography-initial experience[J].Radiology,2007,242:403-409.
[16]贾志豪.92例冠脉支架植入术后患者冠脉造影与64排螺旋CT检查结果分析[D].新疆:新疆医科大学,2008:
[17]Carbone I,Francone M,Algeri E,et al.Non-invasive evaluation of coronary artery stent evaluation with retrospectively ECG-gated 64-slice CT angiography [J].EurRadiol,2008,18:234-243.
[18]Nakamura K,Funabashi N,Uehara M,et al.Impairment factors for evaluating the patency of drug-eluting stents and bare metal stents in coronary arteries by 64-slice computed tomography versus conventional coronary angiography[J].Int J Cardiol,2008,130:349-356.
[19]Pugliese F,Weustink A,Van Mieghem C,et al.Dual-source coronary computed tomography angiography for detecting in-stent restenosis[J].Heart,2008,94:848-854.
[20]Carraba N,Bamoshmoosh M,Carusi LM,et al.Usefulness of 64-slice multi-detector computed tomography for detecting drug eluting in-stent restenosis [J].Am J Cardiol,2007,100:1754-1758.
[21]Oncel D,Oncel G,Tastan A,et al.Evaluation of coronary stent patency and in-stent restenosis with dual-source CT coronary angiography without heart rate control[J].Am J Roentgenol,2008,191:56-63.
[22]Manghat M,Van Lingen R,Hewson P,et al.Usefulness of 64-detector row computed tomography for evaluation of intracoronary stents in symptomatic patients with suspected in-stent restenosis[J].Am J Cardiol,2008,101:1567-1573.
[23]Hecht HS,Zafic M,Jelnin V,et al.Usefulness of 64-detector computed tomographic angiography for diagnosing in-stent restenosis in native coronary arteries [J].Am J Cardiol,2008,101:820-824.
[24]凌志青.64排螺旋CT冠脉成像技术和临床运用研究[D].上海:复旦大学,2008:
[25]Pflederer T,Marwan M,Renz A,et al.Noninvasive assessment of coronary in-stent restenosis by dual-source computed tomography[J].Am J Cardiol,2009,103:812-817.
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[27]Gaspar T,Halon DA,Lewis BS,et al.Diagnosis of coronary in-stent restenosis with multidetector row spiral computed tomography[J].Am J Coll Cardiol,2005,46:1573-1579.
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[29]Maintz D,Juergens KU,Wichter T,et al.Imaging of coronary artery stents using multislice computed tomography:in vitro evaluation[J].Eur Radiol,2003,13:830-835.
[30]Pugliese F,Cademartifi E,van Mieghem C,et al.Multidetector CT for visualization of coronary stents[J].Radiographics,2006,26:887-904.
[2]Holmes Jr DR,Leon MB,Moses JW,et al.Analysis of 1-year clinical outcomes in the SIRIUS trial:a randomized trial of a sirolimus-eluting stent versus a standard stent in patients at high risk for coronary restenosis[J].Circulation,2004,109:634- 640.
[3]Moses JW,Leon MB,Popma JJ,et al.SIRIUS Investigators.Sirolimus-eluting stents versus standard stents in patients with stenosis in a native coronary artery[J].N Engl J Med,2003,349:1315-1323.
[4]Morice MC,Colombo A,Meire B,et al.Sirolimus-vs paclitaxel-eluting stents in de novo coronary artery lesions:the REALITY trial:a randomized controlled trial [J].JAMA,2006,295:895-904.
[5]Fine JJ,Hopkins CB,Ruff N,et al.Comparison of accuracy of 64-slice cardiovascular computed tomography with coronary angiography in patients with suspected coronary artery disease[J].Am J Cardiol,2006,97:173-174.
[6]Miller JM,Rochitte CE,Deway M,et al.Diagnostic Performance of Coronary Angiography by 64-Row CT[J].N Engl J Med,2008,359:2324-2336.
[7]Eagle KA,Guyton RA,Davidoff R,et al.ACC/AHA 2004 guideline update for coronary artery bypass graft surgery:A report of American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Update the 1999 Guidelines for Coronary Artery Bypass Graft Surgery)[C].Circulation,2004,110:e340-e437.
[1]Fischman DL,Leon MB,Baim DS,et al.A randomized comparison of coronary-stent placement and balloon angioplasty in the treatment of coronary artery disease[J].Stent Restenosis Study Investigators N Engl J Med,1994,331:496-501.
[2]Kiemeneij F,Serruys PW,Macaya C,et al.Continued benefit of coronary stenting versus balloon angioplasty:5-year clinical follow-up of Benestent-I trial[J].Am J Coll Cardiol,2001,37:1598-1603.
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[5]Ligabue G,Rossi R,Ratti C,et al.Noninvasive evaluation of coronary artery stents patency after PTCA:role of multislice computed tomography[J].Radiol Med (Torino),2004,108:128-137.
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[7]Gaspar T,Halon DA,Lewis BS,et al.Diagnosis of coronary in-stent restenosis with multi-detector row spiral computed tomography[J].Am J Coil Cardiol,2005,46:1573-1579.
[8]Maintz D,Juergens KU,Wichter T,et al.Imaging of coronary artery stents using multislice computed tomography:in vitro evaluation[J].Eur Radiol,2003,13:830-835.
[9]Mahnken AH,Muhlenbruch G,Seyfarth T,et al.64-Slice computed tomography assessment of coronary artery stents:a phantom study[J].Acta Radiol,2006,47:36-42.
[10]Oncel D,Oncel G,Karaca M.Coronary stent patency and in-stent restenosis: determination with 64-section multidetector CT coronary angiography-initial experience[J].Radiology,2007,242:403-409.
[11]Rist C,von Zeigler F,Nikolaou K,et al.Assessment of coronary artery stent patency and restenosis using 64-slice computed tomography[J].Acad Radiol,2006,13:1465-1473.
[12]Ehara M,Surmely JF,Kawai M,et al.Diagnostic accuracy of 64-slice multislice computed tomography for detecting angiographically significant coronary artery stenosis in an unselected consecutive patient population:comparison with conventional invasive angiography[J].Circ J,2006,70:564-571.
[13]Schuijf JD,Bax JJ,Jukema JW,et al.Feasibility of assessment of coronary stent patency using 16-slice computed tomography[J].Am J Cardiol,2004,94:427-430.
[14]Cademartiri F,Mollet N,Lemos PA,et al.Usefulness of Multislice Computed Tomographic Coronary Angiography to assess in-stent restenosis[J].Am J Cardiol,2005,96:799-802.
[15]Chabbert V,Carrie D,Bennaceur M,et al.Evaluation of in-stent restenosis in proximal coronary arteries with multidetector computed tomography[J].Eur Radiol,2007,17(6):1452-1463.
[16]Kefer JM,Coche E,Vanoverschelde JL,et al.Diagnostic accuracy of 16-slice multidetector-row CT for detection of in-stent restenosis vs detection of stenosis in nonstented coronary arteries[J].Eur Radiol,2007,17:87-96.
[17]Nakamura K,Funabashi N,Uehara M,et al.Impairment factors for evaluating the patency of drug-eluting stents and bare metal stents in coronary arteries by 64-slice computed tomography versus conventional coronary angiography[J].Int J Cardiol,2008,130:349-356.
[18]Rixe J,Achenbach S,Ropers D,et al.Assessment of coronary artery stent restenosis by 64-slice multi-detector computed tomography[J].Eur Heart J,2006,27:2567-2572.
[19]Carrabba N,Bamoshmoosh M,Carusi LM,et al.Usefulness of 64-slice multi-detector computed tomography for detecting drug eluting in-stent restenosis[J].Am J Cardiol,2007,100:1754-1758.
[20]Das KM,El-Menyar AA,Salam AM,et al.Contrast-enhanced 64-section coronary multidetector CT angiography versus conventional coronary angiography for stent assessment[J].Radiology,2007,245:424-432.
[21]Cardemartiri F,Schuijf JD,Pugliese F,et al.Usefulness of 64-slice multislice computed tomography coronary angiography to assess in-stent restenosis[J].Am J Coll Cardiol,2007,49:2004-2010.
[22]Leschka S,Wildermuth S,Boehm T,et al.Noninvasive coronary angiography with 64-section CT:Effect of average heart rate and heart rate variability on image quality[J].Radiology,2006,241:378-385.
[23]Husmann L,Leschka S,Desbiolles L,et al.Coronary artery motion and cardiac phases:dependency on heart rate-implications for CT image reconstruction[J].Radiology,2007,245:567-576.
[24]Gilard M,Cornily JC,Pennec PY,et al.Assessmentofcoronary artery stents by 16 slice computed tomography[J].Heart,2006,92:58-61.
[25]Pugliese F,Weustink A,Van Mieghem C,et al.Dual-source coronary computed tomography angiography for detecting in-stent restenosis[J].Heart,2008,94,848-854.
[26]Pflederer T,Marwan M,Renz A,et al.Noninvasive assessment of coronary in-stent restenosis by dual-source computed tomography[J].Am J Cardiol,2009,103:812-817.
[27]Kastrati A,Mehilli J,Dirschinger J,et al.Intracoronary stenting and angiographic results:strut thickness effect on restenosis outcome(ISAR-STEREO)trail[J].Circulation,2001,103:2816-2821.
[28]Briguori C,Sarais C,Pagnotta P,et al.In-stent restenosis in small coronary arteries:impact of strut thickness[J].Am J Coll Cardiol,2002,40:403-409.
[29]Maintz D,Seifarth H,Raupach R,et al.64-slice multidetector coronary CT angiography:in vitro evaluation of 68 different stents[J].Eur Radiol,2006,16:818-826.
[30]Leschka S,Alkadhi H,Plass A,et al.Accuracy of MSCT coronary angiography with 64-slice technology:first experience[J].Eur Heart J,2005,26:1482-1487.
[31]Nieman K,Rensing BJ,van Geuns RJ,et al.Non-invasive coronary angiography with multislice spiral computed tomography:impact of heart rate[J].Heart,2002,88:470-474.
[32]Raff GL,Gallagher MJ,O'Neil,et al.Diagnostic accuracy of noninvasive coronary angiography using 64-slice spiral computed tomography[J].Am J Coll Cardiol,2005,46:552-557.
[33]Husmann L,Alkadhi H,BoehmT,etal.Influence of cardiac hemodynamic parameters on coronary artery opacificaion with 64-slice computed tomography [J].Eur Radiol,2006,16:1111-1116.
[34]Hecht HS,Zaric M,Jelnin V,et al.Usefulness of 64-detector computed tomography angiography for diagnosing in-stent restenosis in native coronary arteries[J].Am J Cardiol,2008,101:820-824.
[35]Morin RL,Gerber TC,McCollough CH.Radiation dose in computed tomography of the heart[J].Circulation,2003,107:917-922.
[36]Ketelsen D,Thomas C,Werner M,etal.Dual-source computed tomography:Estimation of radiation exposure of ECG-gated and ECG-triggered coronary angiography[J].Eur J Radiol,2008,doi:10.1016/j.ejrad.2008.10.033.
[1]BARI investigators.Comparison of coronary bYPass surgery with angioplasty in patients with multivessel diseflkge[J].N Engl J Med,1996,335:217-225.
[2]Hamm CW,Reimers J,IschingerT,etal.A randomized study of coronary angioplasty compared with bypass surgery in patients with symptomatic multivessel coronary disease[J].N Engl J Med 1994,331:1037-1043.
[3]Goldman S,Sadina K,Moritz T,et al.Long-term patency of saphenous vein and left internal mammary artery grafts after coronary artery bypass surgery:results from a Department of Veterans Affairs Cooperative Study[J].Am J Coll Cardiol,2004,44:2149-2156.
[4]Ropers D,Ulzheimers S,Wenkel E,et al.Investigation of aortocoronary artery bypass grafts by multislice spiral computed cosmography with electrocardiographic-gated image reconstruction[J].Am J Cardiol,2001,88:792-795.
[5]Anders K,Baum U,Schmid Michael,et al.Coronary artery bypass graft(CABG)patency:Assessment with high-resolution submillimeter 16-slice multidetector-row computed tomography(MDCT)versus coronary angiography[J].Eur Radiol,2006,57:336-344.
[6]Schlosser T,Konorza T,Hunold P,et al.Noninvasive visualization of coronary artery bypass grafts using 16-detector row computed tomography[J].Am J Coll Cardiol,2004,44,1224-1229.
[7]Chiurlia E,Menozzi M,Ratti C,et al.Follow-up of coronary artery bypass graft patency by multislice computed tomography[J].Am J Cardiol,2005,95:1094-1097.
[8]Martuscelli E,Romagnoli A,D'Eliseo A,et al.Evaluation of venous and arterial conduit patency by 16-slice spiral computed tomography[J].Circulation,2004,110:3234-3238.
[9]Ropers D,Pohle FK,Kuettner A,et al.Diagnostic accuracy of noninvasive coronary angiography in patients after bypass surgery using 64-slice spiral computed tomography with 330-ms antry rotation[J].Circulation,2006,114,2334-2341.
[10]Pache G,Saueressig U,Frydrychowicz A,et al.Initial experience with 64-slice cardiac CT:non-invasive visualization of coronary artery bypass grafts[J].Eur Heart J,2006,27:976-980.
[11]Onuma Y,Tanabe K,Chihara R,et al.Evaluation of coronary artery bypass grafts and native coronary arteries using 64-slice multidetector computed tomography[J].Am J Heart,2007,154:519-526.
[12]Andreini D,Pontone G,Ballerini G,et al.Bypass graft and native postanastomotic coronary artery patency:Assessment with computed tomography [J].Ann ThoracSurg,2007,83:1672-1678.
[13]Oncel D,Oncel G,Tastan A,et al.Evaluation of coronary bypass graft occlusion and stenosis with 64-detector-row computed tomography angiography[J].Acta Radiol,2007,48:988-996.
[14]Malagutti P,Nieman K,Meijboom WB,et al.Use of 64-slice CT in symptomatic patients after coronary bypass surgery:evaluation of grafts and coronary arteries
[J].Eur Heart J,2007,28:1879-1885.
[15]Jabara R,Chronos N,Klein L,et al.Comparison of multidetector 64-slice computed tomographic angiography to coronary angiography to assess the patency of coronary artery bypass grafts[J].Am J Cardiol,2007,99,1529-1534.
[16]Meyer TS,Martinoff S,Hadamitzky M,et al.Improved noninvasive assessment of coronary artery bypass grafts with 64-slice computed tomographic angiography in an unselected patient population[J].Am J Coll Cardiol,2007,49:946-950.
[17]Nazeri I,Shahabi P,Tehrai M,et al.Assessment of patients after coronary artery bypass grafting using 64-slice computed tomography[J].Am J Cardiol,2009,103:667-673.
[18]Garrett HE,Dennis EW,DeBakey ME.Aortocoronary bypass with saphenous vein graft.Seven-year follow-up[J].JAMA,1973,223:792-794.
[19]Debiolles L,Leschka S,Plass A,et al.Evaluation of temporal windows for coronary artery bypass graft imaging with 64-slice CT[J].Eur Radiol,2007,17:2819-2828.
[20]Einstein A J,Henzlova M J,Rajagopalan S.Estimating risk of cancer associated with radiation exposure from 64-slice computed tomography coronary angiography [J].JAMA,2007,298:317-323.
[1]Lowe HC,Oesterle SN,Khachigian LM.Coronary in-stent restenosis:current status and future strategies[J].Am J Coll Cardiol,2002,39:183-193.
[2]Serruys PW,de Jaegere P,Kiemeneij F,et al.A comparison of balloon-expandable-stent implantation with balloon angioplasty in patients with coronary artery disease[J].Benestent Study Group.N Engl J Med,1994,331:489-495.
[3]Fischman DL,Leon MB,Balm DS,et al.A randomized comparison of coronary-stent placement and balloon angioplasty in the treatment of coronary artery disease[J].N Engl J Med,1994,331::496-501.
[4]Holmes Jr DR,Leon MB,Moses JW,et al.Analysis of 1-year clinical outcomes in the SIRIUS trial:a randomized trial of a sirolimus-eluting stent versus a standard stent in patients at high risk for coronary restenosis[J].Circulation,2004,109:634-640.
[5]Morice MC,Colombo A,Meire B,et al.Sirolimus-vs paclitaxel-eluting stents in de novo coronary artery lesions:the REALITY trial:a randomized controlled trial [J].JAMA,2006,295:895-904.
[6]Fine JJ,Hopkins CB,Ruff N,et al.Comparison of accuracy of 64-slice cardiovascular computed tomography with coronary angiography in patients with suspected coronary artery disease[J].Am J Cardiol,2006,97:173-174.
[7]Miller JM,Rochitte CE,Deway M,et al.Diagnostic Performance of Coronary Angiography by 64-Row CT.N Engl J Med,2008,359:2324-2336.
[8]Hamon M,Champ-Rigot L,Morello R,et al.Diagnostic accuracy of in-stent coronary restenosis detection with multislice spiral computed tomography:a meta-analysis[J].EurRadiol,2006,18:217-225.
[9]Rixe J,Achenbach S,Ropers D,et al.Assessment of coronary artery stent restenosis by 64-slice multi-detector computed tomography[J].Eur Heart J,2006,27:2567-2572.
[10]Rist C,von Seigler F,Nikolaou K,et al.Assessment of coronary artery stent patency and restenosis using 64-slice computed tomography[J].Acad Radiol,2006,13:1465-1473.
[11]Das KM,EI-Menyar AA,Salam AM,et al.Contrast-enhanced 64-section coronary multidetector CT angiography versus conventional coronary angiography for stent assessment[J].Radiology,2007,245:424-432.
[12]Schuijf JD,Pundziute G,Jukema JW,et al.Evaluation of patients with previous coronary stents implantation with 64-section CT[J].Radiology,2007,245:416-423.
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