基于CT血管成像的斑块定量分析在冠状动脉血流动力学异常诊断中的应用价值

目的:探讨基于冠状动脉CT血管成像(CCTA)分析斑块定量指标在冠状动脉血流动力学异常诊断中的应用价值。方法:回顾性病例对照研究。纳入2020年7—10月天津医科大学总医院行CCTA检查的冠状动脉单支或多支局限性狭窄患者104例(共检出病变血管200支)的临床及影像学资料，其中男63例、女41例，年龄45~83岁。依据...

Application value of quantitative plaque analysis based on CT vascular imaging in the diagnosis of coronary artery hemodynamic abnormalities

Objective To explore the value of quantitative plaque analysis using coronary computed tomography angiography (CCTA) in the diagnosis of coronary artery hemodynamic abnormalities.Methods Retrospective(case-control)study. A retrospective analysis was performed on 104 patients (with a total of 200 vessels) who underwent CCTA examination in Tianjin Medical University General Hospital from July to October 2020. The patients included 63 males and 41 females aged 45-83 years old. The 200 blood vessels were divided into two groups according to the computed tomography-derived fractional flow reserve (CT-FFR) value (abnormal hemodynamics group: CT-FFR≤0.80, normal hemodynamics group: CT-FFR＞0.80). A semi-automatic plaque analysis software was used to measure quantitative plaque indexes, such as target vascular lesion length, lumen volume, total plaque volume, calcification volume, lipid volume, fiber volume, minimal lumen area (MLA), stenosis grade (SG), remodeling index, eccentricity index, and fat attenuation index. Univariate analysis, multivariate logistic regression analysis, and Pearson correlation analysis were used to analyze the data. Two models were designed based on the statistical analyses: Model 1 (use SG to determine cardiac hemodynamic abnormalities) and Model 2 (use SG + statistically significant quantitative plaque indicators to determine cardiac hemodynamic abnormalities). Receiver operating characteristic (ROC) curve was used to compare the efficacy of the two models in the diagnosis of hemodynamic abnormalities.Results Univariate analysis showed statistical differences in lesion length, total plaque volume, calcification volume, MLA, and SG (Z=-2.613, -2.356, -2.435, -7.499, -5.516; all P values＜0.05). Multivariate logistic regression analysis showed that MLA was an independent predictor of abnormal coronary artery hemodynamics (odds ratio=0.653, 95% CI interval=0.509-0.838, P＜0.01). Pearson correlation analysis showed that lesion length, MLA, and SG were linearly correlated with CT-FFR (r=-0.41, 0.49, -0.49; all P values＜0.05). The areas under the ROC curve were 0.730 (95% CI 0.659-0.800) and 0.804 (95% CI 0.757-0.875) for Model 1 (SG only) and Model 2 (SG + quantitative indicators of plaque with statistical significance), respectively. Model 2 showed higher diagnostic efficacy (net reclassification improvement=0.181, P＜0.05) than Model 1.Conclusions Among the quantitative indices, coronary plaque, lesion length, MLA, and SG are the influence factors of hemodynamic abnormality, and MLA is the independent predictor of hemodynamic abnormalities. CCTA can apparently increase the diagnostic accuracy of hemodynamic abnormalities by combining lesion length, total plaque volume, calcified volume, and MLA with SG.