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Medizinische Fakultät - Digitale Hochschulschriften der LMU - Teil 09/19 Podcast
Nichtinvasive Koronarangiographie mit Mehrzeilen-Spiral-Computer-Tomographie (MSCT) bei Patienten mit Brustschmerz

Nichtinvasive Koronarangiographie mit Mehrzeilen-Spiral-Computer-Tomographie (MSCT) bei Patienten mit Brustschmerz

Medizinische Fakultät - Digitale Hochschulschriften der LMU - Teil 09/19 vor 17 Jahren

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The coronary display within the multislice computer tomography
(MSCT) enables an exact insight into the intra-coronary conditions,
based on the three dimensional reconstruction of the singular
slices. The existence of calcium plaques indicates
Arteriosclerosis, but also the pre-stages of calcium, which cannot
definitely be diagnosed in percutaneous coronary angiography, can
be detected by MSCT due to the distinction of density given in
Hounsfield-Units (HU). If the density is below 90 HU the concretion
attached to the endothelium is defined as soft plaques, up to 129
HU it is called fibrous and above 130 HU calcium plaques. The
non-calcificated pre-stages, also described by Davies as
“vulnerable Plaques”, tend to become disrupted even stronger than
the relatively solid calcium plaques and therefore are responsible
for a bigger part of myocardial infarcts. This prospective clinical
trial examines the validity of a prognostic statement concerning
the occurrence of acute coronary syndrome caused by plaques related
to intra-coronary concretions within a period of six months after a
4-slice MSCT-scanning of the heart. 416 individuals (259 male and
157 female) suffering from chest pain, were observed from May 2001
to December 2002. End points of the study are the incidence of a
myocardial infarct, catheter revascularisation or lethality. The
sensitivity for the correct prediction of myocardial incidence
within the six successive months is evaluated in this study at 97%
for the male population and 89% for the female population. The
negative prediction is 0.99 for male and 0.98 for female. Despite
the representative occurrence of end points of the study and
despite that the method is valid and reliable under statistical
aspects, the prognostic significance of MSCT has to be treated
carefully, also on account of the short examination period of six
months. Based on individual diagnostic findings, benefits and
future options of MSCT concerning non-invasive heart diagnostics
could be demonstrated. In addition to it’s eligibility to control
the degree of stenosis of venous and arterial bypasses including
the sections of insertion and it’s ability to detect coronary
anomalies the MSCT method should provide a calcium mass score
according to Hong, to enable the documentation of the plaques
progress or expansion.