Мультидетекторная компьютерная томография коронарных артерий пока не может заменить традиционную коронароангиографию
§Ј §б§а§г§Э§Ц§Х§Я§Ъ§Ц §Ф§а§Х§н §У §Ь§С§й§Ц§г§д§У§Ц §С§Э§о§д§Ц§в§Я§С§д§Ъ§У§Я§а§Ф§а §Я§Ц§Ъ§Я§У§С§Щ§Ъ§У§Я§а§Ф§а §Ю§Ц§д§а§Х§С §У§н§с§У§Э§Ц§Я§Ъ§с §а§Т§г§д§в§е§Ь§д§Ъ§У§Я§н§з §б§а§в§С§Ш§Ц§Я§Ъ§Ы §Ь§а§в§а§Я§С§в§Я§н§з §С§в§д§Ц§в§Ъ§Ы §Т§н§Э§С §б§в§Ц§Х§Э§а§Ш§Ц§Я§С §Ю§е§Э§о§д§Ъ§Х§Ц§д§Ц§Ь§д§а§в§Я§С§с §Ь§а§Ю§б§о§р§д§Ц§в§Я§С§с §д§а§Ю§а§Ф§в§С§ж§Ъ§с (§®§Ґ §¬§ґ-§Ь§а§в§а§Я§С§в§а§Ф§в§С§ж§Ъ§с). §ґ§Ц§Ю §Я§Ц §Ю§Ц§Я§Ц§Ц, §Ц§Ц §Х§Ъ§С§Ф§Я§а§г§д§Ъ§й§Ц§г§Ь§С§с §д§а§й§Я§а§г§д§о §е §Т§а§Э§о§Я§н§з §г §г§Ъ§Ю§б§д§а§Ю§С§Ю§Ъ §Ь§а§в§а§Я§С§в§Я§а§Ы §Т§а§Э§Ц§Щ§Я§Ъ §г§Ц§в§Х§и§С (§¬§ў§і) §а§Ь§а§Я§й§С§д§Ц§Э§о§Я§а §Я§Ц §а§б§в§Ц§Х§Ц§Э§Ц§Я§С, §д§С§Ь§Ш§Ц §Ь§С§Ь §Ъ §г§б§а§г§а§Т§Я§а§г§д§о §б§в§а§Ф§Я§а§Щ§Ъ§в§а§У§С§д§о §Я§Ц§а§Т§з§а§Х§Ъ§Ю§а§г§д§о §У §б§в§а§и§Ц§Х§е§в§С§з §в§Ц§У§С§г§Ь§е§Э§с§в§Ъ§Щ§С§и§Ъ§Ъ. §ї§д§Ъ §Щ§С§Х§С§й§Ъ §в§Ц§к§С§Э§Ъ§г§о §У §б§в§а§г§б§Ц§Ь§д§Ъ§У§Я§а§Ю §Ъ§г§г§Э§Ц§Х§а§У§С§Я§Ъ§Ъ CORE 64 (Coronary Artery Evaluation Using 64-Row Multidetector Computed Tomography Angiography), §б§в§а§У§Ц§Х§Ц§Я§Я§а§Ю §У 9 §и§Ц§Я§д§в§С§з §і§є§Ў, §¤§Ц§в§Ю§С§Я§Ъ§Ъ, §Б§б§а§Я§Ъ§Ъ, §ў§в§С§Щ§Ъ§Э§Ъ§Ъ, §¬§С§Я§С§Х§н, §і§Ъ§Я§Ф§С§б§е§в§С §Ъ §Ї§Ъ§Х§Ц§в§Э§С§Я§Х§а§У §е §б§С§и§Ъ§Ц§Я§д§а§У §г §б§а§Х§а§Щ§в§Ц§Я§Ъ§Ц§Ю §Я§С §¬§ў§і, §Я§С§б§в§С§У§Э§Ц§Я§Я§н§з §Х§Э§с §У§н§б§а§Э§Я§Ц§Я§Ъ§с §д§в§С§Х§Ъ§и§Ъ§а§Я§Я§а§Ы §в§Ц§Я§д§Ф§Ц§Я§а§Ь§а§Я§д§в§С§г§д§Я§а§Ы §Ь§а§Э§Ъ§й§Ц§г§д§У§Ц§Я§Я§а§Ы §Ь§а§в§а§Я§С§в§а§С§Я§Ф§Ъ§а§Ф§в§С§ж§Ъ§Ъ (§¬§Ў§¤).
§Ј §Ъ§г§г§Э§Ц§Х§а§У§С§Я§Ъ§Ц §Т§н§Э §У§Ь§Э§р§й§Ц§Я 291 §б§С§и§Ъ§Ц§Я§д §У §У§а§Щ§в§С§г§д§Ц §г§д§С§в§к§Ц 40 §Э§Ц§д (§г§в§Ц§Х§Я§Ъ§Ы §У§а§Щ§в§С§г§д ЁC 59 §Э§Ц§д; §Ю§е§Ш§й§Ъ§Я§н ЁC 74%) §Т§Ц§Щ §У§н§в§С§Ш§Ц§Я§Я§а§Ы §Ь§С§Э§о§и§Ъ§ж§Ъ§Ь§С§и§Ъ§Ъ §Ь§а§в§а§Я§С§в§Я§н§з §С§в§д§Ц§в§Ъ§Ы §б§в§Ъ §®§Ґ §¬§ґ-§д§а§Ю§а§Ф§в§С§ж§Ъ§Ъ (§г§й§Ц§д §б§а Agatston ЎЬ 600). §Ї§Ц§б§а§г§в§Ц§Х§г§д§У§Ц§Я§Я§а §б§Ц§в§Ц§Х §¬§Ў§¤ (§У §г§в§Ц§Х§Я§Ц§Ю §Щ§С 10 §й§С§г§а§У) §е§й§С§г§д§Я§Ъ§Ь§Ъ §б§а§Х§У§Ц§в§Ф§С§Э§Ъ§г§о §Х§У§е§Ю §¬§ґ-§д§Ц§г§д§С§Ю §г §Ъ§г§б§а§Э§о§Щ§а§У§С§Я§Ъ§Ц§Ю 64-§г§в§Ц§Щ§а§У§а§Ф§а §г§Ь§С§Я§Ц§в§С (Aquilion, Toshiba Medical Systems): §а§и§Ц§Я§Ь§Ц §Ь§а§в§а§Я§С§в§Я§а§Ф§а §Ь§С§Э§о§и§Ъ§Я§а§Щ§С §Ъ §Ь§а§в§а§Я§С§в§а§Ф§в§С§ж§Ъ§Ъ. §Є§Щ§е§й§Ц§Я§Ъ§р §б§а§Х§Э§Ц§Ш§С§Э§Ъ §г§Ц§Ф§Ю§Ц§Я§д§н §Ь§а§в§а§Я§С§в§Я§н§з §С§в§д§Ц§в§Ъ§Ы §Х§Ъ§С§Ю§Ц§д§в§а§Ю 1,5 §Ю§Ю §Ъ §Т§а§Э§Ц§Ц, §к§С§Ф §г§в§Ц§Щ§С §г§а§г§д§С§У§Э§с§Э 0,5 §Ю§Ю. §©§С§Ь§Э§р§й§Ц§Я§Ъ§с §б§а §®§Ґ §¬§ґ-§Ь§а§в§а§Я§С§в§а§Ф§в§С§ж§Ъ§Ъ §Ъ §¬§Ў§¤ §Х§С§У§С§Э§Ъ§г§о §Х§У§е§Ю§с §Я§Ц§Щ§С§У§Ъ§г§Ъ§Ю§н§Ю§Ъ §Ъ§г§г§Э§Ц§Х§а§У§С§д§Ц§Э§с§Ю§Ъ §и§Ц§Я§д§в§С§Э§о§Я§н§з §Э§С§Т§а§в§С§д§а§в§Ъ§Ы, §б§в§Ъ §г§е§л§Ц§г§д§У§Ц§Я§Я§а§Ю §в§С§г§з§а§Ш§Х§Ц§Я§Ъ§Ъ §Ъ§з §Ю§Я§Ц§Я§Ъ§Ы §б§в§Ъ§У§Э§Ц§Ь§С§Э§г§с §д§в§Ц§д§Ъ§Ы §г§б§Ц§и§Ъ§С§Э§Ъ§г§д. §¤§Ц§Ю§а§Х§Ъ§Я§С§Ю§Ъ§й§Ц§г§Ь§Ъ §Щ§Я§С§й§Ъ§Ю§н§Ю (§а§Т§г§д§в§е§Ь§д§Ъ§У§Я§н§Ю) §б§а§в§С§Ш§Ц§Я§Ъ§Ц§Ю §г§й§Ъ§д§С§Э§г§с §г§д§Ц§Я§а§Щ §Ь§а§в§а§Я§С§в§Я§а§Ы §С§в§д§Ц§в§Ъ§Ъ ЎЭ 50%.
§Ґ§Ъ§С§Ф§Я§а§г§д§Ъ§й§Ц§г§Ь§С§с §д§а§й§Я§а§г§д§о §®§Ґ §¬§ґ-§Ь§а§в§а§Я§С§в§а§Ф§в§С§ж§Ъ§Ъ §У §г§в§С§У§Я§Ц§Я§Ъ§Ъ §г §¬§Ў§¤ §У §а§д§Я§а§к§Ц§Я§Ъ§Ъ §а§Т§г§д§в§е§Ь§д§Ъ§У§Я§н§з §б§а§в§С§Ш§Ц§Я§Ъ§Ы §Ъ §б§а§г§Э§Ц§Х§е§р§л§Ъ§з §в§Ц§У§С§г§Ь§е§Э§с§в§Ъ§Щ§С§и§Ъ§Ы §Ю§Ъ§а§Ь§С§в§Х§С §а§и§Ц§Я§Ъ§У§С§Э§С§г§о §б§а §б§Э§а§л§С§Х§Ъ §б§а§Х §з§С§в§С§Ь§д§Ц§в§Ъ§г§д§Ъ§й§Ц§г§Ь§а§Ы §а§б§Ц§в§С§д§а§в§г§Ь§а§Ы §Ь§в§Ъ§У§а§Ы (ROC).§©§Я§С§й§Ъ§Ю§н§Ц §г§д§Ц§Я§а§Щ§н §Ь§а§в§а§Я§С§в§Я§н§з §С§в§д§Ц§в§Ъ§Ы §б§в§Ъ §¬§Ў§¤ §а§д§Ю§Ц§й§Ц§Я§н §е 163 (56%) §Т§а§Э§о§Я§н§з, §У §д§а§Ю §й§Ъ§г§Э§Ц §а§Х§Я§а-, §Х§У§е§з- §Ъ §д§в§Ц§з§г§а§г§е§Х§Ъ§г§д§н§Ц §б§а§в§С§Ш§Ц§Я§Ъ§с §У 27%, 21% §Ъ 8% §г§Э§е§й§С§Ц§У. §±§в§Ъ §С§Я§С§Э§Ъ§Щ§Ц §Т§а§Э§о§Я§н§з §Х§Ъ§С§Ф§Я§а§г§д§Ъ§й§Ц§г§Ь§С§с §д§а§й§Я§а§г§д§о §®§Ґ §¬§ґ-§Ь§а§в§а§Я§С§в§а§Ф§в§С§ж§Ъ§Ъ §г§а§г§д§С§У§Ъ§Э§С 0,93 (95% §Х§а§У§Ц§в§Ъ§д§Ц§Э§о§Я§н§Ы §Ъ§Я§д§Ц§в§У§С§Э 0,90ЁC0,96) §г §й§е§У§г§д§У§Ъ§д§Ц§Э§о§Я§а§г§д§о§р 85% (79ЁC90%) §Ъ §г§б§Ц§и§Ъ§ж§Ъ§й§Я§а-§г§д§о§р 90% (83ЁC94%). §°§Х§Я§С§Ь§а §Х§Ъ§С§Ф§Я§а§г§д§Ъ§й§Ц§г§Ь§Ъ§Ц §Щ§Я§С§й§Ц§Я§Ъ§с §б§а§Э§а§Ш§Ъ§д§Ц§Э§о§Я§а§Ф§а §Ъ §а§д§в§Ъ§и§С§д§Ц§Э§о-§Я§а§Ф§а §в§Ц§Щ§е§Э§о§д§С§д§С §а§Ь§С§Щ§С§Э§Ъ§г§о §Я§Ц§Х§а§г§д§С§д§а§й§Я§а §У§н§г§а§Ь§Ъ§Ю§Ъ: 91% (86ЁC95%) §Ъ 83% (75ЁC89%) §г§а§а§д§У§Ц§д§г§д§У§Ц§Я§Я§а.
§±§в§Ъ §С§Я§С§Э§Ъ§Щ§Ц §а§д§Х§Ц§Э§о§Я§н§з §Ь§а§в§а§Я§С§в§Я§н§з §г§а§г§е§Х§а§У (n=866) §Х§Ъ§С§Ф§Я§а§г§д§Ъ§й§Ц§г§Ь§С§с §д§а§й§Я§а§г§д§о §®§Ґ §¬§ґ-§Ь§а§в§а§Я§С§в§а§Ф§в§С§ж§Ъ§Ъ §а§Ь§С§Щ§С§Э§С§г§о §г§а§б§а§г§д§С§У§Ъ§Ю§а§Ы §г §¬§Ў§¤: 0,91 (0,88ЁC0,93). §±§в§Ъ §п§д§а§Ю §й§е§У§г§д§У§Ъ§д§Ц§Э§о§Я§а§г§д§о §Ъ §г§б§Ц§и§Ъ§ж§Ъ§й§Я§а§г§д§о §г§а§г§д§С§У§Ъ§Э§Ъ 75% (69ЁC81%) §Ъ 93% (90ЁC94%), §С §б§в§а§Ф§Я§а§г§д§Ъ§й§Ц§г§Ь§Ъ§Ц §Щ§Я§С§й§Ц§Я§Ъ§с §б§а§Э§а§Ш§Ъ§д§Ц§Э§о§Я§а§Ф§а §Ъ §а§д§в§Ъ§и§С§д§Ц§Э§о§Я§а§Ф§а §в§Ц§Щ§е§Э§о§д§С§д§С ЁC 82% (77ЁC86%) §Ъ 89% (86ЁC92%) §г§а§а§д§У§Ц§д§г§д§У§Ц§Я§Я§а.§Ј §д§Ц§й§Ц§Я§Ъ§Ц 30 §г§е§д§а§Ь §б§а§г§Э§Ц §¬§Ў§¤ 98 §б§С§и§Ъ§Ц§Я§д§а§У §б§а§Х§У§Ц§в§Ф§Э§Ъ§г§о §а§б§Ц§в§С§и§Ъ§с§Ю §Ь§а§в§а§Я§С§в§Я§а§Ы §в§Ц§У§С§г§Ь§е§Э§с§в§Ъ§Щ§С§и§Ъ§Ъ. §®§Ґ §¬§ґ-§Ь§а§в§а§Я§С§в§а§Ф§в§С§ж§Ъ§с §а§Ь§С§Щ§С§Э§С§г§о §г§з§а§Х§Я§а§Ы §г §¬§Ў§¤ §б§а §г§б§а§г§а§Т§Я§а§г§д§Ъ §Ъ§Х§Ц§Я§д§Ъ§ж§Ъ§Ь§С§и§Ъ§Ъ §д§С§Ь§Ъ§з §Т§а§Э§о§Я§н§з: §б§Э§а§л§С§Х§о §б§а§Х ROC §г§а§г§д§С§У§Ъ§Э§С 0,84 (0,79ЁC0,88) §б§в§а§д§Ъ§У 0,82 (0,77ЁC0,86) §г§а§а§д§У§Ц§д§г§д§У§Ц§Я§Я§а.
§®§Ґ §¬§ґ-§Ь§а§в§а§Я§С§в§а§Ф§в§С§ж§Ъ§с §Х§а§г§д§С§д§а§й§Я§а §д§а§й§Я§а §У§н§с§У§Э§с§Ц§д §Я§С§Э§Ъ§й§Ъ§Ц §Ъ §д§с§Ш§Ц§г§д§о §а§Т§г§д§в§е§Ь§д§Ъ§У§Я§н§з §б§а§в§С§Ш§Ц§Я§Ъ§Ы §Ь§а§в§а§Я§С§в§Я§а§Ф§а §в§е§г§Э§С §Ъ §в§Ъ§г§Ь §б§а§г§Э§Ц§Х§е§р§л§Ц§Ы §в§Ц§У§С§г§Ь§е§Э§с§в§Ъ§Щ§С§и§Ъ§Ъ §Ю§Ъ§а§Ь§С§в§Х§С §е §Т§а§Э§о§Я§н§з §г §г§Ъ§Ю§б§д§а§Ю§С§Ю§Ъ §¬§ў§і.
§ґ§Ц§Ю §Я§Ц §Ю§Ц§Я§Ц§Ц, §г §е§й§Ц§д§а§Ю §б§в§а§Ф§Я§а§г§д§Ъ§й§Ц§г§Ь§Ъ§з §Щ§Я§С§й§Ц§Я§Ъ§Ы §б§а§Э§а§Ш§Ъ§д§Ц§Э§о§Я§а§Ф§а §Ъ §а§д§в§Ъ§и§С§д§Ц§Э§о§Я§а§Ф§а §в§Ц§Щ§е§Э§о§д§С§д§С (91% §Ъ 83%) §®§Ґ §¬§ґ-§Ь§а§в§а§Я§С§в§а§Ф§в§С§ж§Ъ§с §Я§Ц §г§б§а§г§а§Т§Я§С §б§в§а§г§д§а §Щ§С§Ю§Ц§Я§Ъ§д§о §д§в§С§Х§Ъ§и§Ъ§а§Я§Я§е§р §¬§Ў§¤ §У §п§д§а§Ы §б§а§б§е§Э§с§и§Ъ§Ъ §б§С§и§Ъ§Ц§Я§д§а§У. §Ї§Ц§а§Т§з§а§Х§Ъ§Ю§н §Х§С§Э§о§Я§Ц§Ы§к§Ъ§Ц §Ъ§г§г§Э§Ц§Х§а§У§С§Я§Ъ§с §Х§Э§с §а§б§в§Ц§Х§Ц§Э§Ц§Я§Ъ§с §Ю§Ц§г§д§С §®§Ґ §¬§ґ-§Ь§а§в§а§Я§С§в§а§Ф§в§С§ж§Ъ§Ъ §У §Х§Ъ§С§Ф§Я§а§г§д§Ъ§й§Ц§г§Ь§а§Ю §С§Э§Ф§а§в§Ъ§д§Ю§Ц §а§и§Ц§Я§Ь§Ъ §Т§а§Э§о§Я§н§з §г §б§а§Х§а§Щ§в§Ц§Я§Ъ§Ц§Ю §Я§С §¬§ў§і, §Щ§С§Ь§Э§р§й§С§р§д §С§У§д§а§в§н §б§е§Т§Э§Ъ§Ь§С§и§Ъ§Ъ.Miller J.M., Rochitte C.E., Dewey M. et al. Diagnostic performance of coronary angiography by 64-row CT. N Engl J Med. November 27, 2008;359:2324-36.
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