法医学杂志

法医学杂志 ›› 2013, Vol. 29 ›› Issue (6): 401-404.DOI: 10.3969/j.issn.1004-5619.2013.06.001

• 论著 •    下一篇

多层螺旋CT冠状动脉钙化积分在评价冠心病猝死中的应用

万  雷1，应充亮1，刘宁国1，夏文涛1，王亚辉1，魏  华1，2，朱广友1   

  1. （1. 司法部司法鉴定科学技术研究所 上海市法医学重点实验室，上海 200063； 2. 华东政法大学研究生教育学院，上海 200042）
  • 发布日期:2013-12-25 出版日期:2013-12-28
  • 通讯作者: 朱广友，男，研究员，硕士研究生导师，主要从事法医临床学研究及鉴定工作；E-mail：zgy@ssfjd.cn
  • 作者简介:万雷（1982—），男，江苏徐州人，硕士，助理研究员，主要从事法医放射学研究；E-mail：wanlei-820628@163.com
  • 基金资助:

    “十二五”国家科技支撑计划项目（2012BAK16B02）

Application of MSCT’s Coronary Artery Calcification Score in Evaluation of Sudden Death Caused by Coronary Artery Disease

WAN LEI1, YING CHONG-LIANG1, LIU NING-GUO1, XIA WEN-TAO1, WANG YA-HUI1, WEI HUA1,2, ZHU GUANG-YOU1   

  1. （1. Shanghai Key Laboratory of Forensic Medicine, Institute of Forensic Science, Ministry of Justice, P.R.China, Shanghai 200063, China; 2. Graduate School of East China University of Political Science and Law, Shanghai 200042, China）
  • Online:2013-12-25 Published:2013-12-28

被引次数

2

摘要： 目的 通过运用多层螺旋CT（multi-slice spiral computed tomography，MSCT）冠状动脉钙化积分（coronary artery calcium scoring，CACS）的方法，评价其在冠心病（coronary artery disease，CAD）猝死案例中的法医学应用价值，为虚拟解剖鉴定CAD猝死探索有效手段。 方法 收集9例进行法医学鉴定的心源性猝死案例，尸体解剖前均进行MSCT扫描。通过Agatston’s法对每例冠状动脉钙化程度进行定量分析，并计算CACS，钙化积分＞400作为存在CAD的评判标准，并与尸体解剖结果比较。 结果 经尸体解剖证实CAD猝死的9例案例中仅有2例钙化积分>400，CACS对CAD的预测率仅为22.2%。MSCT检查与系统尸体解剖均发现CAD猝死案例中普遍存在不同程度肺水肿改变，冠状动脉左前降支较其他分支发生管腔狭窄的发病率高。 结论 运用MSCT并结合计算CACS可对CAD猝死案例中冠状动脉钙化明显的进行检测，而钙化不明显的需要辅以如尸体血管造影等其他技术。

关键词: 法医病理学, 体层摄影术, 螺旋计算机, 心脏, 冠状血管, 钙化, 尸体解剖

Abstract: Objective To access application value of multi-slice spiral computed tomography （MSCT） and coronary artery calcium scoring （CACS） in investigation the coronary artery disease （CAD）, and to explore the effective way of virtual autopsy to evaluate the sudden death due to CAD. Methods Nine cases of sudden cardiac death were collected to analyze MSCT before the autopsy. The quantitative analysis of the degree of coronary artery calcium was made by Agatston’s method. The CACS of all the subjects were calculated based on the diagnostic criteria for CAD, in which calcium scoring was more than 400. The results of CACS were compared with that of the autopsy. Results Only 2 cases got the high calcium scoring which were more than 400 in the 9 cases died of CAD confirmed by the autopsy. The prediction rate of CACS for CAD was only 22.2%. Pulmonary edema of different severity was found in both autopsy and MSCT. There was a higher morbidity rate in the left anterior descending of coronary artery than the other branches. Conclusion Obvious calcification of coronary artery can be detected by MSCT and calculating CACS. To detect subtle calcification needs other technologies such as postmortem angiography.

Key words: forensic pathology, tomography, spiral computed, heart, coronary vessel, calcification, autopsy

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