臨床検査53巻10号

2009年10月発行

今月の主題 血栓症と臨床検査 各論 〈血栓症の画像診断〉

急性冠症候群の画像診断

著者： 安斉俊久¹

所属機関： ¹慶應義塾大学医学部循環器内科

ページ範囲：P.1153 - P.1157

　急性冠症候群(ACS)の画像診断は，責任冠動脈病変を同定し，経皮的冠動脈インターベンションを施行する際のストラテジーを立てるうえで極めて重要である．冠動脈造影や血管内超音波に加え，最近ではmultidetector-row computed tomographyによって，ACSを診断し，リスクを層別化するのみならず，将来ACSをきたす可能性のある不安定粥腫を検出する試みもなされている．これらの画像診断の進歩は，ACSの病態解明にも寄与するものと考えられる．

参考文献

1) Ambrose JA, Winters SL, Stern A, et al：Angiographic morphology and the pathogenesis of unstable angina pectoris. J Am Coll Cardiol　5：609-616, 1985

2) Takahashi T, Anzai T, Yoshikawa T, et al：Absence of preinfarction angina is associated with a risk of no-reflow phenomenon after primary coronary angioplasty for a first anterior wall acute myocardial infarction. Int J Cardiol　75：253-260, 2000

3) Goldstein JA, Demetriou D, Grines CL, et al：Multiple complex coronary plaques in patients with acute myocardial infarction. N Engl J Med　343：915-922, 2000

4) Oemrawsingh PV, Mintz GS, Schalij MJ, et al：Intravascular ultrasound guidance improves angiographic and clinical outcome of stent implantation for long coronary artery stenoses：final results of a randomized comparison with angiographic guidance(TULIP Study). Circulation　107：62-67, 2003

5) Mintz GS, Nissen SE, Anderson WD, et al：American College of Cardiology Clinical Expert Consensus Document on Standards for Acquisition, Measurement and Reporting of Intravascular Ultrasound Studies(IVUS). A report of the American College of Cardiology Task Force on Clinical Expert Consensus Documents. J Am Coll Cardiol　37：1478-1492, 2001

6) Jinzaki M, Sato K, Tanami Y, et al：Novel method of displaying coronary CT angiography：Angiographic view. Circ J　70：1661-1662, 2006

7) Hoffmann U, Moselewski F, Nieman K, et al：Noninvasive assessment of plaque morphology and composition in culprit and stable lesions in acute coronary syndrome and stable lesions in stable angina by multidetector computed tomography. J Am Coll Cardiol　47：1655-1662, 2006

8) Ueno K, Anzai T, Jinzaki M, et al：Diagnostic capacity of 64-slice multidetector computed tomography for acute coronary syndrome in patients presenting with acute chest pain. Cardiology　112：211-218, 2009

9) Keelan PC, Bielak LF, Ashai K, et al：Long-term prognostic value of coronary calcification detected by electron-beam computed tomography in patients undergoing coronary angiography. Circulation　104：412-417, 2001

10) Schmermund A, Baumgart D, Görge G, et al：Coronary artery calcium in acute coronary syndromes：a comparative study of electron-beam computed tomography, coronary angiography, and intracoronary ultrasound in survivors of acute myocardial infarction and unstable angina. Circulation　96：1461-1469, 1997