64层螺旋CT与冠状动脉血管造影评估冠状动脉侧支循环的对照研究

目的 评估64层螺旋CT(MSCT)显示冠状动脉侧支循环(CCC)的能力.方法 回顾性分析2005年8月至2007年4月间接受64层MSCT冠状动脉成像(64-MSCTA)且影像质量良好的患者,经冠状动脉造影(CAG)证实至少有1支冠状动脉主要分支狭窄程度≥90%.以Rentrop评价标准为金标准,评价64-MSCTA判断CCC的准确性.在CAG影像上按照Wemer冠状动脉侧支连接(CC)标准分为CC0、CC1、CC2 3组;在64-MSCTA影像上按照新的冠状动脉侧支分级方法 (MSCT-CC)评价,应用Kappa系数检验评估这两种分级标准的一致性.结果共有97例患者人组,其中37例CAG影像上发现至少1处CCC(共62支),33例64-MSCTA发现至少1处CCC(共47支).以CAG为金标准,64-MSCTA发现CCC患者的敏感性为89.2%(33/37),特异性为93.8%(60/64);发现CCC血管的敏感性为75.8%(47/62).将CAG和64-MSCTA均诊断的CCC按照Werner标准分组,其中CC0组4支、CC1组24支、CC2组19支;按照MSCT-CC标准分组,其中MSCT-CC0组7支、MSCT-CC1组22支、MSCT-CC2组18支.CAG和64-MSCTA对CCC的分级标准间存在较高的一致性(Kappa=0.857,P<0.01).结论64-MSCTA可以较准确地评估CCC.

Evaluation of the coronary collateral circulation with 64-sUce spiral CT: a comparative study with coronary angiography

Objective To evaluate the ability of 64-slice spiral CT(64-MSCT) in demonstrating the coronary collateral circulation(CCC).Methods Patients undergoing 64- MSCT coronary angiography with relatively good image quality from August 2005 to April 2007 were entered into the study according to following requirements: patients underwent a traditional coronary artery angiography (CAG) after the coronary CT imaging; the CAG showed there was stenosis greater than 90% in at least one major coronary artery.The CCCs were assessed in CAG by the Rentrop grading, and the CAG served as the gold standard to determine the accuracy of 64-MSCT angiography in detecting collateral circulations.All CCCs were grouped angiographieally into three groups of CC0, CC1 ,and CC2 by Werner collateral collection(CC) grading.In the 64-MSCT coronary angiography imaging, a new grading(MSCT-CC) was used to evaluate CCCs.The consistency between these two grading standards was analyzed by Kappa test.Resalts A total of 97 patients were entered into the study, among whom at least one CCC was found by CAG in 37 patients and at least one CCC was detected by 64-MSCT angiography.Taken the CAG results as the reference standard, the sensitivity and specificity of the 64-MSCT angiography in detecting patients with the CCCs were 89.2% (33/37) and 93.8% (60/64) respectively.The sensitivity of the 64-MSCT angiography detecting the CCCs was 75.8% (47/62). All the CCCs detected by CAG and 64-MSCT angiography were grouped into three groups according to Werner grading: 4 in CC0 group, 24 in CC1 group and 19 in CC2 group.The CCCs were grouped into three groups according to MSCT-CC: 7 in MSCT-CC0 group, 22 in MSCT-CC1 group and 18 in MSCT-CC3 group.The consistency of the two grading criteria was relatively high (Kappa = 0.857, P < 0.01).Conclusion 64-MSCT angiography can accurately evaluate the coronary collateral circulation.