64层螺旋CT对冠状动脉狭窄病变诊断准确性的对比研究

目的比较64层螺旋CT(64-MSCT)冠状动脉显像和选择性冠状动脉造影(SCA)诊断冠状动脉狭窄的准确性。方法华西医院2004年4月至2010年12月行SCA检查并同期行64-MSCT检查患者共93例,其中男74例,女19例;年龄(58.2±8.5)岁,全部患者为窦性心律,心率≥90次/分患者使用倍他乐克控制心律,选取管腔内径≥2 mm的可显像冠状动脉节段,管腔内径狭窄≥50%确定为冠状动脉节段狭窄。根据节段显示情况及是否存在伪影将图像质量分为Ⅰ～Ⅳ级,Ⅰ～Ⅲ级符合影像学评价要求。以SCA造影检查结果为金标准,评价64-MSCT显像成象质量及检测冠状动脉节段狭窄病变的准确性。结果 SCA能清晰显像的冠状动脉节段(100%,1 238/1 238),造影图象质量均符合冠状动脉成像质量评价方法中可评价图象要求(Ⅰ～Ⅲ级);64-MSCT评价冠状动脉有无狭窄的总体敏感度、特异度、阳性及阴性预测值分别为88.8%(427/481)、91.7%(694/757)、87.1%(427/490)和92.8%(694/748)。64-MSCT造影对左回旋支近段和第一钝缘支病变的诊断准确率较其他节段低:左回旋支近段的敏感度68.3%(41/60),特异度60.6%(20/33),阳性预测值75.9%(41/54),阴性预测值51.3%(20/39);第一钝缘支的敏感度58.8%(10/17),特异度93.5%(58/62),阳性预测值71.4%(10/14),阴性预测值89.2%(58/65)。影响冠状动脉狭窄判断和图象质量的主要因素是冠状动脉钙化和心脏活动伪影。结论 64-MSCT诊断冠状动脉狭窄具有较高的准确性,具体评价与病变检测受解剖部位和血管大小的影响,对左回旋支近段及第一钝缘支病变的诊断准确率较低。

Accuracy of Detecting Coronary Artery Stenosis Between 64-multislice Spiral CT and Selective Coronary Angiography:A Comparative Study

Objective To evaluate the diagnostic accuracy for the the assessment of coronary artery stenoses using 64-multislice spiral computed tomography(64-MSCT)scanner compared with selective coronary angiography(SCA).Methods 64-MSCT and SCA were both performed in 93 patients with 74 males and 19 females at mean age of(58.2±8.5)years in West China Hospital between April 2004 and December 2010.The cardiac rhythm of all the patients was stably sinus.Patients with initial heart rates ≥90 time/min were received treatments of β-blockers.All available coronary segments(internal diameter ≥ 2.0 mm)were included in the evaluation.Lesions with ≥ 50% luminal narrowing were considered as significant stenosis.According to the image detail of segments and existance of artfacts,the image quality was randed Ⅰ to Ⅳ,with rank Ⅰ to Ⅲ meeting demands of image evaluation.Evaluations had been done concerning the 64-MSCT scanner for detecting the stenosis of the variant branches or segments of the coronary artery.Results 64-MSCTprovided a full image correspondence(100%,1 238/1 238)of all the segments clearly displayed in the SCA.All of the coronary segments involved(n=1 238)met the quality demands of being evaluated as rankⅠ to Ⅲ.Considering SCA as the golden standard,overall sensitivity for classifying stenosis using 64-MSCT scanner was 88.8%(427/481),specificity was 91.7%(694/757),positive predictive value was 87.1%(427/490),and negative predictive value was 92.8%(694/748).While the stenosis diagnostic accuracy of proximal left circumflex branch and the first obtuse marginal branch of left coronay artery is lower than other branches:the sensitivity of the proximal left circumflex branch was 68.3%(41/60),specificity was 60.6%(20/33),positive predictive value was 75.9%(41/54),negative predictive value was 51.3%(20/39);the sensitivity of the first obtuse marginal branch was 58.8%(10/17),specificity was 93.5%(58/62),positive predictive value was 71.4%(10/14),negative predictive value was 89.2%(58/65).Arterial wall calcification and false image of cardiac movements were the main influence factors for accuracy of the the assessment of coronary artery stenosis with 64-MSCT scanner.Conclusion 64-MSCT scanner provids a high diagnostic accuracy in assessing stenosis of the coronary artery.The anatomical location and luminal area of coronary artery were the main influence factors of diagnostic accuracy.Thus the diagnostic accuracy in proximal left circumflex branch and the first obtuse marginal branch of left coronary artery was lower than other coronary segments.