双源 CT 和冠状动脉造影评估冠状动脉支架内再狭窄的比较研究

目的：研究双源 CT（DSCT）和冠状动脉造影（CAG）评估冠状动脉支架内再狭窄的一致性及前者取代后者的可行性。方法137例患者193枚支架均行 CAG 检查及 DSCT 检查判断是否存在支架内再狭窄（ISR），以 CAG 结果为金标准，比较 DSCT 评估支架狭窄的敏感性、特异性、阳性预测值、阴性预测值、准确性。结果137例患者193枚支架，CAG 评估为 ISR 共计61枚，DSCT 正确判断57枚，其敏感性89．4％、特异性88．5％、阳性预测值80．3％、阴性预测值96．7％、准确性90．7％；在 P ＜0．05水准上检验得 Kappa 值为0．5463，DSCT 评估与 CAG 评估 ISR 有较好的一致性；146枚直径≥3．0 mm 支架，CAG 判断46枚 ISR，DSCT 准确判断44枚，其敏感性95．6％、特异性90％、阳性预测值81．5％、阴性预测值97．8％、准确性91．8％；直径＜3．0 mm 的47枚支架，CAG 判断15枚 ISR，DSCT 正确判断13枚，其敏感性86．7％、特异性87．5％、阳性预测值76．5％、阴性预测值93．3％、准确性87．2％。结论DSCT评估 ISR 与 CAG 相比有很好的一致性，但受支架置入部位及大小影响判断，易出现误判及判断 ISR 程度较重，但在大寸径的支架通畅情况的评估基本可以取代 CAG。

Comparative study of coronary artery in stent restenosis assessment of dual source CT with coronary artery angiography

Objective To study of dual source CT （DSCT）and coronary angiography （CAG）of dual source CT coronary artery restenosis of stent （DSCT）and coronary angiography （CAG）in diagnosis of coronary artery in stent rest-enosis consistency and former feasibility.Methods 137 cases underwent CAG examination of in stent restenosis （ISR） patients received DSCT examination again in the informed consent,evaluating a total of 193 stents in two kinds of inspection methods of the degree of stenosis.Comparison of DSCT evaluation of stent stenosis sensitivity,specificity,positive predictive value,and negative predictive value,accuracy.Results CAG was evaluated in 137 patients with 193 stents,to determine the ISR a total of 61 medals,DSCT assessment correctly judge the 57 pieces,4 pieces of missed diagnosis,misdiagnosis 14 pieces,DSCT sensitivity of 89.4%,specificity of 88.5%,positive predictive value of 80.3%, negative predictive value of 96.7%,accuracy of 90.7%;DSCT evaluation and CAG evaluation of ISR are in good agreement at the P 〈0.05 level test,Kappa value was 0.5463;146 pieces of diameter ≥ 3.0mm scaffolds,CAG display 46 stents restenosis,DSCT accurately showed 44 pieces,2 pieces of missed diagnosis,misdiagnosis 10 pieces,DSCT sensitivity of 95.6%,specificity of 90%,positive predictive value of 81.5%,negative predictive value of 97.8%,accuracy 91.8%;diameter 〈 47 3.0mm stents,CAG display 15 pieces of restenosis,DSCT display 13 restenosis,missed 2,misdiagnosed in 4 pieces,DSCT sensitivity of 86.7%,specificity of 87.5%,positive predictive value of 76.5%,negative predictive value of 93.3%,accuracy of 87.2%.Conclusion Compared DSCT assessment of ISR and CAG have good consistency,sensitivity,satisfactory accuracy,especially in the big inch diameter to assess the patency of stent can replace the CAG.