目的 探讨64层螺旋CT评估冠状 动脉斑块的位置分布、性质及稳定性的应 用价值。方法 回顾性分析我院收治的初 诊为冠状动脉性心脏病(Coronary heart disease,CHD)患者157例,均接受64层螺旋 CT检查，纳入观察组。另选同期157例非 急性冠脉综合征患者，纳入对照组。两 组患者冠状动脉扫描原始数据传至后处 理工作站，由2名CT医生使用心脏标准算 法对图像进行重建，选40%、46%、70%、 75%收缩期，找出质量最佳、图片效果最 好的图像进行处理，然后重建最大密度投 影、曲面重建、多平面重建，测量斑块CT 值。结果 观察组共检出157个斑块，检出 率100%。对照组患者中共检出124斑块， 检出率78.98%，观察组冠状动脉软斑块、 混合斑块检查率显著高于对照组，钙化斑 块检出低于对照组(P<0.05)。观察组与对 照组共分析520段冠状动脉。观察组患者 中动脉狭窄共175段，其中89段为重度狭 窄，46段中度狭窄，40段轻度狭窄。对照 组患者中动脉狭窄有201段，其中24段为 重度狭窄，中度狭窄19段，轻度狭窄158 段。观察组冠状动脉狭窄率高于对照组 (P<0.05)，观察组重度冠状动脉狭窄率、 正常率显著高于对照组(P<0.05)。64层螺 旋CT评价狭窄程度轻度、中度、重度灵敏 性分别为73.24%、80.78%、87.54%，狭窄 程度轻度、中度、重度特异性95.69%、 96.54%、97.24%各项指标略有差异，但 仍有较高的准确性及特异性。157枚斑块 数量由多到少分布：LAD2、LAD1、RCA1/ D1、LCX1、LM/LAD3、PLV/PDA/LCX2、 RCA3、D2/OM、RCA2。斑块类型(钙化斑 块、非钙化斑块、混合斑块)与管腔狭窄 程度(轻、中、重度)有关(P<0.05)。结论 64层螺旋CT可有效评估冠状动脉斑块的位 置分布、性质及稳定性，指导临床治疗。

Objective To investigate the value of 64-slice spiral CT in the evaluation of the location, properties and stability of coronary plaque. Methods The clinical data of 157 cases of CHD (observation group) and 157 cases of non-acute coronary syndrome (control group) underwent 64-slice spiral CT examinations in our hospital were analyzed retrospectively. Images were reconstructed by maximum intensity projection (MIP), curved planar reformation (CPR), multiple planar reformation (MPR) methods. Then the CT value of coronary plaque was calculated based on the digital image postprocessing algorithms. Results The total detection rate of plaque was 100% (157 cases) in the observation group and 78.98% (124) in the control group; the observation group had higher detection rate of soft plaque and mixed plaque as well as lower detection rate of calcified plaque than those of the control group (P<0.05), a total of 520 plaques were checked, including 157 cases of arteriostenosis in observation group and 201 cases of arteriostenosis in the control group. The coronary artery stenosis rate in the observation group was higher than that in the control group (P<0.05). The coronary artery stenosis was severe in 89 cases, moderate in 46 cases and mild in 40 cases in the observation group, and these were 24 cases, 19 cases and 158 cases in the control group, respectively. The severe coronary artery stenosis rate and normal rate in the observation group were significantly higher than those in the control group (P<0.05). The sensitivity and specificity of 64-slice spiral CT in the evaluation of mild, moderate and severe coronary artery stenosis were 73.24%/95.69%, 80.78%/96.54% and 87.54%/97.24%. The distribution of the plaques ranked in a descending order was LAD2, LAD1, RCA1/D1, LCX1, LM/ LAD3, PLV/PDA/LCX2, RCA3, D2/OM, RCA2. The types of plaque (calcified, noncalcified, mixed) were related to the coronary artery stenosis degree (mild, moderate and severe) (P<0.05). Conclusion 64-slice spiral CT can evaluate the location, properties and stability of coronary plaque effectively, which is worthy of clinical application.