钙化积分、CTCA以及两者联合对冠状动脉狭窄的诊断价值

目的:探讨冠状动脉钙化积分(CS)、CT冠状动脉成像(CTCA)以及两者联合对诊断冠状动脉狭窄病变的价值.方法:189例患者均行冠状动脉钙化积分扫描、CT冠状动脉成像以及传统冠状动脉造影(CAG)检查.计算CS、CT-CA以及两者联合诊断冠状动脉病变的符合率,并记录有效X线剂量.结果:189例患者中临床诊断为冠心病156例(82.5％),经冠状动脉造影检测出至少有1支冠状动脉狭窄≥50％.采用钙化积分250分作为诊断阈值,检测冠状动脉狭窄≥50％的敏感度和特异度分别为42.9％(67/156)和96.9％(32/33).CTCA检测冠状动脉狭窄≥50％的敏感度和特异度分别为98.1％(153/156)和72.7％(24/33).CS和CTCA联合时,检测冠状动脉狭窄≥50％的敏感度和特异度分别为96.2％(150/156)和87.9％(29/33).结论:钙化积分对诊断冠状动脉狭窄有着很高的特异度；CTCA对诊断冠状动脉狭窄有着很高的敏感度；CTCA联合钙化积分扫描可提高冠状动脉狭窄的诊断符合率.

Value of calcium scoring, CT angiography and combination of the two in the diagnosis of coronary artery stenoses

Objective：To investigate the diagnostic accuracy of CT coronary angiography（CTCA）,calcium scoring（CS） and the combination of the two in the diagnosis of coronary artery stenoses,and compared with conventional coronary angiography（CAG）.Methods：One hundred and eighty nine patients underwent CS,CTCA and CAG,the diagnostic accuracy was calculated for CS,CTCA and the combination of the two,the results were correlated with that of CAG.Effective radiation doses were calculated.Results：Of the 189 patients with clinically diagnosed as coronary artery disease,156 patients（82.5%） had at least 1 branch of coronary artery（CA） stenoses ≥50% detected by CAG.When using CS cut-off value as 250 to diagnose CA stenosis ≥50%,the sensitivity and specificity of CS was 42.9%（67/156） and 96.9%（32/33）,respectively.For CTCA,the sensitivity and specificity was 98.1%（153/156） and 72.7%（24/33）,respectively in detecting CA stenoses ≥50%.CS in combination with CTCA,the sensitivity and specificity was 96.2%（150/156） and 87.9%（29/33）,respectively.Conclusion：CS allows the diagnosis of significant CA stenoses with a high diagnostic specificity,while CTCA shows reasonably high sensitivity for detecting significant obstructive CAD.CTCA combined with calcium score scan can improve the diagnostic accuracy of coronary artery stenoses.