不同成分斑块螺旋CT冠状动脉成像及常规冠状动脉成像对照探究.docVIP

不同成分斑块螺旋CT冠状动脉成像及常规冠状动脉成像对照探究 　【摘要】 目的: 研究16层多层螺旋CT（MDCT）冠状动脉成像和常规冠状动脉成像（CCA）对不同成分斑块狭窄程度判断的相关性，并评估MDCT冠状动脉成像对冠状动脉狭窄诊断的准确性。方法: 收集检查时间间隔≤1个月的MDCT冠状动脉成像和CCA齐备的影像资料，对发现的斑块根据成分划分为完全钙化斑块、混和性斑块和软斑块。以病人为单位根据斑块性质分别计算中度及中度以上狭窄的敏感度、特异度、阳性预测值、阴性预测值。结果: 以CCA与MDCT评价完全钙化斑块、混和性斑块及软斑块三者之狭窄程度的相关系数分别为0.364、0.854、0.773，总体相关系数为0.610。以病人为单位，16层MDCT判断冠脉中度及中度以上狭窄敏感度、特异度、阳性预测值、阴性预测值为91.30%、80%、91.30%、80%；按完全钙化斑块、混和性斑块、软斑块则分别为83.33%、77.78%、45.45%、95.45%；100%、100%、100%、100%；90.91%、91.30%、90.91%、95.45%。结论: MDCT冠状动脉造影对混合型斑块及软斑块造成的狭窄程度能作出较可靠的判断，但易过度评价钙化斑块的狭窄程度。16层MDCT冠脉成像基本上能满足冠心病对可疑或中、低风险病人筛选性初步诊断的需要。 【关键词】 冠心病 体层摄影术 X线计算机 冠状动脉成像 Abstract: Objective: To investigate the correlation between the 16-slice multi-detector row CT (MDCT) and conventional angiography (CCA) in grading of coronary artery stenosis caused by different plaques and to evaluate the diagnostic accuracy in the assessment of coronary artery stenosis using 16-slice MDCT angiography. Methods: A total of 33 patients underwent both MDCT and conventional coronary angiography. MDCT angiography and CCA images were retrospectively analyzed. The degree of stenosis was evaluated using eye-measurement. Plaques were classified as completely calcified，mixed and soft plaque based on their composition. The effect of the composition of the plaques on the stenosis and the relationship between the extent of the calcified plaque and the degree of stenosis were evaluated. The sensitivity，specificity， positive and negative predictive value of 16-slice MDCT coronary angiography in a segment-based，a vessel-based and a patient-based model were also evaluated. Results: In the grading of atherosclerosis stenosis，the correlation coefficent between the MDCT angiography and CCA was 0.610 in a patient-based model，and 0.364，0.854 and 0.773，respectively for completed calcified，mixed and soft plaque. The sensitivity，specificity，positive and negative predictive value of 16-slice MDCT angiography identified moderate and severe stenosis were 91.30%，80%，91.30% and