目的 探讨64 排螺旋CT冠状动脉成像（CTA）在冠状动脉狭窄诊断中的应用价值。 方法 选取2010年8月－2012 年8月间收治的90例临床诊断或疑似冠心病患者，所有患者均先实施64排螺旋CT冠状动脉CTA，然后所有患者实施常规冠状动脉造影，对比不同诊断方法的诊断结果，评估两种诊断方法对于冠状动脉狭窄的准确率及精确度。 结果 64 排螺旋CT冠状动脉CTA检出1处明显狭窄者36例，冠状动脉造影检出1处明显狭窄者36例，两组检查方法诊断冠状动脉狭窄对比，差异无统计学意义（P＞0.05）。冠状动脉CTA诊断灵敏度为86.12%，特异度为94.21%，阳性预测值为80.33%，阴性预测值为97.11%，冠状动脉造影诊断灵敏度为72.19%，特异度为84.65%，阳性预测值为71.35%，阴性预测值为87.41%。冠状动脉CTA的诊断准确率高于冠状动脉造影，差异有统计学意义（P＜0.05）。 结论 64 排螺旋CT冠状动脉CTA诊断冠状动脉狭窄的准确度及灵敏度都较高，对早期轻度狭窄诊断灵敏度优于传统动脉造影，对于辅助患者治疗具有重要作用，值得在临床推广应用。
Objective To evaluate the accuracy of preoperative 64 multidetector spiral computed tomography (MDCT) in the diagnosis of stage Ⅳ gastric cancer. Methods The data of patients with stage Ⅳ gastric cancer between July 2007 and April 2008 were collected. Twenty-nine patients underwent preoperative 64 MDCT were retrospectively analyzed. All computed tomography scans were prospectly analyzed by 2 abdominal radiologists separately. Pathological tumor stage was based on TNM stage according to the revised Japanese Classification of Gastric Carcinoma from the Japanese Gastric Cancer Association. All CT results were compared with clinical, surgical and histopathologic results. Results The 65.2% (15/23), 47.8% (11/23) and 70.8% (17/24) of the stage Ⅳ patients were accurately predicted of T, N and M stage, respectively. Moreover, 58.6% (17/29) of the stage Ⅳ patients were accurately predicted of TNM stage. But 6/9 cases with peritoneal metastases were not detected by preoperative 64 MDCT. Conclusion The 64 MDCT is a promising technique for detection and preoperative staging of stage Ⅳ gastric cancer. It was difficult to detect peritoneal metastases, but it may not increase the rate of exploratory laparotomy.