双源CTA与DSA评价冠状动脉钙化性斑块管腔狭窄对比研究

目的:探讨双源CT冠状动脉成像(DSCTA)评价钙化斑块引起血管腔狭窄的准确性。方法:62例患者DSCTA显示冠状动脉一处或多处钙化斑块,并行冠状动脉造影(CAG)检查。钙化斑块大小分为小、中和大。使用各种后处理技术,以确定钙化斑块引起血管阻塞(狭窄管腔直径≥50%),无血管阻塞(狭窄管腔直径<50%),并与CAG比较。结果:DSCTA显示小钙化斑块122处,中44处,大86处。122处小钙化斑块,5%CAG显示有梗阻;44处中钙化斑块,14%梗阻;86大钙化斑块,42%有梗阻。DSCTA与CAG一致95%(116/122)小钙化斑块、91%(40/44)中钙化斑块、67%(58/86)大钙化斑块。DSCTA低估2例小钙化斑块血管腔狭窄,高估4例小钙化斑块、4例中钙化斑块、28例大钙化斑块血管腔狭窄。86处大钙化斑块引起的血管腔梗阻,DSCTA敏感性100%、特异性44%、阳性预测值56%、阴性预测值100%、准确性67%。结论 DSCTA准确显示90%以上小和中等大小钙化斑块血管阻塞病变,正确诊断约2/3大钙化斑块血管阻塞病变。判断错误通常是高估狭窄程度。

Value of Dual-source CT Coronary Angiography in Evaluating the Degree of Stenosis Caused by Calcified Coronary Artery Plaques

Objective： To investigate how accurate of dual-source computed tomography coronary angiography （DSCTA） is in evaluating the degree of stenosis caused by calcified coronary artery plaques. Methods： 62 patients who had one or more calcified coronary artery plaques of DSCCTA underwent CAG. The size of the calcified coronary artery plaques was graded subjectively as small, moderate, or large. To determine whether the calcified lesions were obstructive （_〉50% diameter narrowing） or nonobstructive （〈50% diameter narrowing）. Concordance with CAG was then determined. Resulds： Calcified coronary artery plaques were graded by DSCTCA as small at 122 locations, moderate at 44 locations, and large at 86 locations. Of the 122 small calcified coronary artery plaques, 5% were obstructive at CAG; of the 44 moderate-sized calcified coronary artery plaques, 14% were obstructive; and of the 86 large calcified coronary artery plaques, 42% were obstructive. Concordance between DSCTCA and CAG occurred in 116 of 122 （95%） small calcified coronary artery plaques, 40 of 44 （91%） moderate-sized coronary artery plaques, and 58 of 86 （67%） large coronary artery plaques. DSCTCA underestimated the degree of stenosis in two small calcified coronary artery plaque but overestimated the degree of stenosis in four small, four moderate, and 28 large coronary artery plaques. In detecting obstructive lesions caused by the 86 large calcified coronary artery plaques, DSCTCA had a sensitivity of 100%, specificity of 44%, positive predictive value of 56%, negative predictive value of 100%, and accuracy of 67%. Conclusion： DSCTCA can be used to accurately predict the presence of obstructive disease in 〉 90% of small and moderate-sized calcified coronary artery plaques. With large calcified coronary artery plaques, DSCTCA correctly predicts the presence of obstructive disease in approximately two thirds of the cases. When errors occur, they are usually due to overestimation of the degree of stenosis.