64层螺旋CT诊断冠状动脉粥样硬化狭窄准确性研究

目的 评价64层螺旋CT(64-MSCT)诊断冠状动脉粥样硬化狭窄的准确性.方法 61例疑似冠心病患者在5～20 d内行64层MSCT冠状动脉成像(CTA)和血管造影(CAG)检查,其中男52例、女9例,平均年龄58岁±11岁.冠状动脉成像质量按照4分标准对右冠状动脉、左主干、左前降支和左回旋支4支血管分别进行评价.CTA与CAG冠状动脉病变狭窄程度以50%为界,对以上4支血管进行评价.对比分析MSCT诊断冠状动脉狭窄程度≥50%和＜50%的敏感性、特异性、假阳性、假阴性等指标.根据斑块的成分将其分为钙化和非钙化斑块两组,对二者所导致的管腔狭窄分别进行分析比较.结果 所有61例患者均获得优良的冠状动脉影像,冠状动脉成像质量评分为(3.57±0.18)分.CTA与CAG对比,诊断冠状动脉狭窄程度灵敏度为95.45%、特异度为96.15%、假阳性率为3.85%、假阴性率4.55%、阳性预测值为93.33%、阴性预测值为97.40%.对于非钙化斑块所致的管腔显著性狭窄的诊断敏感度和特异度均为85.71%;对于钙化斑块所致的显著性狭窄的诊断敏感度和特异度分别为83.33%和31.57%.结论 64-MSCT可准确显示冠状动脉硬化所致狭窄性病变,可用于冠心病的无创性检查,对于钙化斑块所导致的管腔狭窄的判断特异度低.

Diagnostic accuracy of noninvasive coronary artery angiography using 64 multi-slice computed tomography on coronary atherosclerosis

OBJECTIVE: To evaluate the diagnostic accuracy of 64 multislice computed tomography (MSCT) coronary angiography on the coronary atherosclerosis. METHODS: Sixty one (52 male, 9 female, averaged 58 +/- 11 yrs ) patients underwent conventional coronary angiography and 64-MSCT angiography for suspected coronary artery disease within 5 to 20 days. Coronary artery image quality was scored from 1 to 4 (image quality score, 1: poor; 2: good -; 3: good +, and 4: excellent) on RCA, LM, LAD and LCX, respectively. The coronary artery stenosis were divided into two groups by over than 50% and less than 50% and diagnostic accuracy was analyzed. The coronary plaques were divided as calcified and noncalcified plaque according to its density. The stenosis result from calcified and noncalcified plaque were analyzed. RESULTS: Mean score of image quality on RCA, LM, LAD and LCX was 3.57 +/- 0.18 with heart beats 50 - 104 bpm (mean 70 +/- 11 bpm). Compared with CAG, the sensitivity and specificity of 64-MSCT in evaluating stenosis are 94.45% and 96.15%, the false positive and false negative value are 3.85% and 4.55%. The sensitivity and specificity were 85.71% in evaluating stenosis result from noncalcified plaque and they were 83.33% and 31.57% result from calcified plaque. CONCLUSION: 64-MSCT is an accurate and feasible method in evaluating coronary artery stenosis compared to conventional coronary angiography. However the specificity was poor in evaluating calcified plaque.