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< たこつぼ心筋症　その２ | メイン | ＣＲＴ-Ｄ >

専門医の期待に応える６４列ＭＤＣＴの高画質

戯れ言たれる侏儒 / 2007.09.30 00:37 / 推薦数 : 1

少し前にＭＤＣＴによる冠動脈石灰化評価の米国でのトライアルを紹介させていただきました。

エストロゲン療法と冠動脈石灰化
http://blog.m3.com/reed/20070923/1
 

実はＭｅｄｉｃａｌ　Ｔｒｉｂｕｎｅ2007.7.26に人間ドックでの同様の発表が掲載されていました。
肺がん検診の際の胸部ヘリカルＣＴを解析しての研究のようです。（約１０％に冠動脈石灰化を検出という結論です。）

　　　　　　　　野間仁根       裸婦 水彩画
http://page2.auctions.yahoo.co.jp/jp/auction/b68884694

さて本邦でも侵襲的な冠動脈造影から６４列ＭＤＣＴに冠動脈病変の評価法が変わる動きがあるようです。
きょうは「第７回日本心血管カテーテル治療学会」の発表を教材にしてみました。

９０％以上で診断、治療に役立つ画像
　　野崎徳州会病院（大阪府）心臓センター
＃１.　最新のソフトウエアで、不整脈症例（期外収縮、心房細動）を含めて十分満足できる冠動脈ＣＴ画像が得られる。
＃２.　プラークの評価でもＩＶＵＳに近い情報を得ることができる。
＃３.　もはやＣＡＧがゴールドスタンダードではない。ＣＴのほうがよほで正しい診断が出来る。

画像改善に伴い月１６０件まで増加
　　ＣＡＧは４分の１、ＰＣＩは２倍に。
田貫会・高瀬クリニック（群馬県）
＃1.　ＣＡＧは拒否するがＣＴなら受けたいという患者が増えた。
＃２.　きれいなＣＴ画像を撮れば、ＣＡＧに匹敵あるいはそれ以上の情報を提供してくれる。

最初にＣＴ、異常あればＣＡＧ
　　小倉記念病院で検査方針を変更
社会保険小倉記念病院（福岡県）
＃1.　年間４万件以上のＰＣＩ。！！！！！
新患月４００例、ＯＣＩ後の患者が１～２年ごとの約４万人。
（ＭＤＣＴは１日に１５～２０件実施という見込みでスタート）
＃2.　2007.2冠動脈専用６４列ＭＤＣＴが稼動。
＃３.　１日１５件、開始後５か月で１２００件以上を経験。
＃４.　胸痛を訴えて来院する患者には原則として全例施行。
＃５.　撮像上の工夫をすればかなり被爆線量を低減できる。
＃６.　ＰＣＩ後の定期的な冠動脈ＣＴによるプラーク評価で薬物や生活習慣改善のモチベーションを高めることが可能。
＜コメント＞
さすが小倉記念病院です。
検査のためのＣＡＧは、これからどんどんＭＤＣＴにとってかわっていくのでしょうか。
ＰＣＩ後のｒｅｓｔｕｄｙもＣＡＧからＭＤＣＴに変えていくということになるとＭＤＣＴは一体何台いることになるのでしょうか？
余計な心配をしてすいません。

ＭＤＣＴプラーク性状評価とアディポネクチン測定
　　不安定プラーク例の診断に有用
　ＪＡ広島総合病院循環器内科
＃１.　ＡＣＳのリスクは、冠動脈のリモデリングや石灰化、あるいは不安定化プラークの指標である脂質プールなどが認められる場合に高くなる。
＃２.　現在、冠動脈のリモデリングや石灰化はＣＴで検出できるが、プラークの脂質プールを観察するにはＩＶＵＳが必要になる。
＃３.　研究の結果、ＭＤＣＴを用いたプラークのカラー解析により、不安定プラーク（ｓｏｆｔ　ｐｌａｑｕｅ，ｉｎｔｅｒｍｅｄｉａｔｅ　ｐｌａｑｕｅ）を９０％近い正診率で検出できることがわかった。
＃４.　プラークの破綻に対してアディポネクチンは抑制的に働くことが知られている。今回の検討で、最も破綻しやすいｓｏｆｔｐｌａｑｕｅ群で血清アディポネクチン濃度が低下していた。


 

＜コメント＞
末梢血で測定した血清アディポネクチン濃度が冠動脈でのプラーク性状の変化をキャッチできるというのはまさに驚きです。
もっともわれわれ開業医はアディポネクチン濃度を測定することはできません。
まずは診断をしっかりつけていただける６４列ＭＤＣＴをもつ病院を紹介先として確保することが大切ですね。

＜出典＞
第７回日本心血管カテーテル治療学会
Ｍｅｄｉｃａｌ　Ｔｒｉｂｕｎｅ2007.9.20

＜コメント＞
ＭＤＣＴ、ＣＡＧの被爆線量を知りたいと思いました。
下世話な話ですが各保険点数もわかればいいのですが。

患者本人への侵襲はもちろんですが、この２点での侵襲がＭＤＣＴの方が少なければ申し分ありません。

 

読んでいただいてありがとうございました。
コメントをお待ちしています。


＜１０月１日追加＞
検査別被曝線量
http://trhome.med.u-tokai.ac.jp/contents/hibaku_ippan/hibaku_all/senryou.htm
X線やCT検査の放射線は安全？
http://www.inetmie.or.jp/~kasamie/Housyasen0908Asa.shtml
X線撮影・被曝線量一覧表
http://www.hmedc.or.jp/housya/hibakusenryou.htm

<H２０年１月１日追加>

マルチスライスCTによる冠動脈評価
http://www.jc-angiology.org/journal/pdf/2006/157.pdf

 

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[...]always a big fan of linking to bloggers that I love but don’t get a lot of link love from[...]…... [続きを読む]
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≫ Blogs ou should be reading
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posted from articles 2012.05.25 13:47
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≫ Sites we Like…
[...] Every once in a while we choose blogs that we read. Listed below are the latest sites that we ... [続きを読む]
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≫ Links
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