320排CT冠状动脉血管成像与冠状动脉造影评估冠状动脉支架内再狭窄程度的对比分析

目的评价320排CT冠状动脉血管成像(CCTA)在冠状动脉支架内再狭窄评估中的临床应用价值。方法以选择性冠状动脉造影(CAG)为金标准,应用320排CCTA评价100例患者冠状动脉支架内再狭窄的程度。将冠状动脉支架内管径分为无狭窄、轻度狭窄(≤50%)、中度狭窄(51%～75%)和重度狭窄或闭塞(76%～100%)4个等级,分析320排CCTA与CAG评估狭窄程度的一致性。其中再狭窄≥50%为阳性,包括支架内及支架两端5mm范围内的血管段。统计学方法采用Kappa评价方法。结果 100例患者中共评价分析175枚支架,CAG示冠状动脉支架内再狭窄44枚,320排CCTA正确诊断42枚,漏诊2枚,误诊10枚,敏感度为95.45%、特异度为92.37%、准确度为70.29%、阳性预测值为80.77%、阴性预测值为98.37%。在P<0.05的检验标准上,Kappa值为0.5688,320排CCTA和CAG对支架内狭窄程度评估一致性好。结论 320排CCTA能够准确显示支架内再狭窄的部位及程度,而且无创、重复性好,图像直观可信,具有很高的临床应用价值。

Diagnostic value of 320-row computed tomography coronary angiography in detecting coronary in-stent restenosis

Objective To evaluate the diagnostic value of 320-row computed tomography coronary angiography （CTCA） in detecting coronary in-stent restenosis. Methods From January 2010 to March 2011, 100 patients suspected with coronary in-steut restenosis were enrolled in this study. 320-row CTCA was done six months to 5 years after stent implantation. All the patients underwent coronary angiography （CAG） within 2 weeks after CTCA. In-stent restenosis was defined as ≥50% luminal narrowing in the stent or within 5mm of stent edge. Results The sensitivity, specificity, diagnostic accuracy, positive predictive value and negative predictive value of 320-row CTCA in detecting in-stent stenosis were 95.45% , 92. 37% , 70. 29% , 80. 77% , and 98.37% , respectively. Kappa value between CTCA and CAG was 0. 5688 （ P 〈 0. 05 ）. Conclusions 320-row CTCA is an accurate nouinvasive method in detecting coronary in-stent restenosis.