摘要
背景:由于金属材料对多层螺旋CT图像有伪影干扰作用,支架结构中金属管壁厚度和管腔内径也可明显影响多层螺旋CT靶血管支架内纵轴成像质量,但目前仅有少量报道涉及到这方面的问题。目的:观察不同材料的冠状动脉支架及其结构对多层螺旋CT评价靶血管通畅性图像质量的影响,希望实验数据能为改进和完善支架技术提供参考。设计、时间及地点:对比观察,于2006-01/2008-12在沈阳医学院沈洲医院及中国医科大学附属盛京医院完成。对象:纳入接受支架置入的冠状动脉粥样硬化性心脏病患者139例,共置入支架227枚,按置入支架材料和结构分组。不锈钢支架92枚,镍钛合金支架135枚;薄金属壁支架(<140μm)85枚,厚金属壁支架(≥140μm)142枚;小直径支架(<3mm)71枚,大直径支架(≥3mm)156枚。方法:随访期间采用64层螺旋CT机进行冠状动脉扫描,并做常规冠状动脉造影检查,比较不同组别靶血管通畅性图像质量的差异。主要观察指标:采取4分制进行多层螺旋CT图像质量评分,评价多层螺旋CT的敏感度、异度、准确度、阳性预期值与阴性预期值。结果:139例患者共置入支架227枚,按支架材料分组后,不锈钢支架组CT图像质量较差处明显多于镍钛合金组,前者的平均CT图像质量评分、敏感性、特异性、阳性和阴性预测值均明显低于镍钛合金组(P均<0.05)。按支架厚度分组后,厚金属壁支架组CT图像质量较差处明显多于薄金属壁支架组,前者的平均CT图像质量评分、敏感性、特异性、阳性和阴性预测值均明显低于薄金属壁支架组(P均<0.05)。按支架直径分组后,小直径支架组CT图像质量较差处明显多于大直径支架组,前者的平均CT图像质量评分敏感性、特异性、阳性和阴性预测值均明显低于大直径支架组(P均<0.05)。结论:冠状动脉支架金属材料、金属壁厚度和管腔直径均可能影响多层螺旋CT靶血管成像质量。
BACKGROUND： Mental material has shadow intervention effects on multi-slice helical CT （MDCT）. Mental wall thickness and lumens inner diameter in stent structure can significantly affect longitudinal axis imaging quality of MDCT target vessel stent. However, there are few studies involved in this aspect. OBJECTIVE： To analyze the effect of various coronary stent materials and structures on patency images of target vessel by MDCT evaluation, and to provide clinical evidences for improving stent technique. DESIGN, TIME AND SETTING： The comparison observation was conducted at the Shenzhou Hospital, Shenyang Medical College, and Shengjing Hospital, China Medical University from January 2006 to December 2008. PARTICIPANTS： A total of 139 patients with coronary heart disease who were treated with stent implantation were divided into material and construct groups （227 stents were implanted）. There were 92 stainless steel stents, 135 nick-eltitanium alloy stents, 85 thin mental wall stents （140 μm）, 142 thick mental wall stents （≥140 μm）, 71 small diameter stents （ 3 mm）, and 156 big diameter stents （≥3 mm）. METHODS： During following up, patients were checked using 64-slice helical CT and routine coronary arteriongraphy to compare patency images of target vessels in the two groups. MAIN OUTCOME MEASURES： MDCT was scored by four-mark standard to evaluate sensitivity, specificity, accuracy, positive and negative predictive values of MDCT. RESULTS： A total of 227 stents were implanted into 139 patients. CT images of stainless steel stent group were poorer than nickel-titanium alloy group, and the indicators including image score, sensitivity, specificity, positive and negative predictive values of the stainless steel stent group were significantly less than nickel-titanium alloy group （P〈 0.05）. CT images of thick-wall stent were poorer than thin-wall stent, while the indicators including image score, sensitivity, specificity, positive and negative predictive values of the thick-wall stent were significantly less than thin-wall stent （P〈 0.05）. CT images of small-diameter stent were poorer than large-diameter stent, while the indicators including image score, sensitivity, specificity, positive and negative predictive values of the small-diameter stent were significantly less than large-diameter stent （P〈 0.05）. CONCLUSION： Materials, wall thickness and diameter of coronary stent may influence images of target vessels via MDCT evaluation.
出处
《中国组织工程研究与临床康复》
CAS
CSCD
北大核心
2009年第52期10297-10301,共5页
Journal of Clinical Rehabilitative Tissue Engineering Research
基金
辽宁省教育厅基金资助项目(20060888)~~
