双源CT冠状动脉成像对冠状动脉疾病的诊断价值

目的 探讨双源CT(DSCT)冠状动脉成像对冠状动脉疾病的诊断价值.方法 对36例疑有冠心病的患者冠状动脉进行DSCT和冠状动脉造影(CAG)检查,分析比较DSCT冠脉成像对冠状动脉疾病诊断的灵敏度、特异度、阳性预测值、阴性预测值及准确率.结果 36例DSCT冠脉成像与CAG相比较:诊断冠心病的敏感性100.00％,特异性66.67％,阳性预测值93.75％,阴性预测值100.00％,准确率97.20％；配对X2检验(x2 =0.500,P ＞0.05),一致性检验(Kappa值为0.768,P＜0.01).按病变血管计算,其诊断冠脉明显狭窄的敏感性95.24％,特异性96.08％,阳性预测值90.91％,阴性预测值98.00％,准确率95.83％；配对x2检验(McNemar检验)(X2=0.167,P＞0.05),一致性检验(Kappa值为0.899,P＜0.01).DSCT和CAG两种检查方法在评价冠心病及冠状动脉明显狭窄的血管上差异无统计学意义,具有很好的一致性.结论 双源CT对冠心病的诊断准确度接近选择性冠状动脉造影,DSCT与CAG具有较高的符合性与一致性,是一种无创、安全可靠的冠状动脉检查方法.

Clinical value of dual-source CT in evaluating coronary artery disease

Objective To explore the clinical value of dual-source CT（DSCT） in the diagnosis of coronary artery disease by comparing the result of DSCT and coronary angiography（CAG）. Methods From July 2009 to August 2010,36 patients with suspected coronary heart disease underwent both DSCT coronary angiography（DSCTCA） and selective CAG examination. The results of DSCT coronary angiography were compared with CAG which was the gold standard of diagnosing coronary disease. The sensitivity, specificity, positive and negative predictive value, and ac- curacy of DSCT were evaluated. Results 144 coronary arteries were well evaluated of 36 eases. The sensitivity, speci- ficity,positive and negative predictive value, and accuracy of DSCT in the diagnosis of coronary heart disease were 100.00% ,66.67% ,93.75%, 100.00% and 97.20% respectively by the number of patients;The McNemar test showed no significant difference between two methods （ X^2 = 0. 500, P 〉 0.05 ） with a higher diagnosis concordance （Kapp = 0. 768 ,P 〈 0.01 ）. By detecting moderate to severe coronary artery stenosis, the sensitivity, specificity, posi- tive and negative predictive value, accuracy were 95.24% , 96.08% , 90.91%, 98.00% , 95.83 %, respectively. The MeNemar test showed no significant difference between two methods （ X^2 = 0. 167, P 〉 0.05 ） with a higher diagnosis concordance （ Kapp = 0. 899,P 〈 0.01 ）. Conclusion DSCT has a diagnostic accuracy of coronary heart disease close to that CAG, especially in evaluating patients with moderate to severe coronary artery stenosis,it has high compliance and consistency with CAG. DSCT is a noninvasive, safe and reliable radiographic method.