目的 探討64 排螺旋CT冠狀動脈成像（CTA）在冠狀動脈狹窄診斷中的應用價值。 方法 選取2010年8月－2012 年8月間收治的90例臨床診斷或疑似冠心病患者，所有患者均先實施64排螺旋CT冠狀動脈CTA，然后所有患者實施常規冠狀動脈造影，對比不同診斷方法的診斷結果，評估兩種診斷方法對于冠狀動脈狹窄的準確率及精確度。 結果 64 排螺旋CT冠狀動脈CTA檢出1處明顯狹窄者36例，冠狀動脈造影檢出1處明顯狹窄者36例，兩組檢查方法診斷冠狀動脈狹窄對比，差異無統計學意義（P＞0.05）。冠狀動脈CTA診斷靈敏度為86.12%，特異度為94.21%，陽性預測值為80.33%，陰性預測值為97.11%，冠狀動脈造影診斷靈敏度為72.19%，特異度為84.65%，陽性預測值為71.35%，陰性預測值為87.41%。冠狀動脈CTA的診斷準確率高于冠狀動脈造影，差異有統計學意義（P＜0.05）。 結論 64 排螺旋CT冠狀動脈CTA診斷冠狀動脈狹窄的準確度及靈敏度都較高，對早期輕度狹窄診斷靈敏度優于傳統動脈造影，對于輔助患者治療具有重要作用，值得在臨床推廣應用。
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.