双源CT在冠心病诊断中的价值

目的 以侵入性的冠状动脉造影（ICA）为金标准,研究双源CT（DSCT）冠状动脉血管成像在诊断冠状动脉狭窄时的敏感性和特异性,评估其在冠心病筛选中的可行性.方法 回顾性分析200例冠心病患者（包括30例心律失常患者）的临床资料.入选患者均先后进行DSCT和ICA检查,两项检查之间间隔不超过3个月.以ICA为金标准,评价DSCT冠状动脉血管成像在诊断冠心病中的诊断价值.结果 200例冠心病患者中,158例经ICA证实存在冠状动脉狭窄（管腔狭窄≥50%）,而DSCT冠状动脉血管成像诊断161例,其诊断有意义冠状动脉狭窄的敏感性为98.1%（155/158）,特异性为85.7%（36/42）.评估的2 000段冠状动脉中,ICA证实326段存在冠状动脉狭窄（管腔狭窄≥50%）,DSCT诊断326段,敏感性为96.3%（314/326）,特异性为99.3%（1662/1674）.两者结果间差异均无统计学意义（P＞0.05）.并且DSCT对冠状动脉不同程度狭窄的诊断有极高的阴性预测值（均＞99%）. 结论与ICA相比,DSCT对冠状动脉狭窄,尤其是无钙化的冠状动脉狭窄有较高的敏感性、特异性和极高的阴性预测值,且适用人群大为增加,因此,可以考虑将DSCT冠状动脉成像作为冠心病的筛选手段.

Diagnostic value of dual-source computed tomography in coronary artery disease

Objective With invasive coronary angiography (ICA) as the golden standard for diagnosis, to explore the sensitivity and specificity of dual-source computed tomography (DSCT) in the diagnosis of coronary artery stenosis and to confirm DSCT feasibility in screening coronary artery disease (CAD). Methods A total of 200 cases of suspected CAD, including 30 cases of arrhythmia, were retrospectively analyzed. The patients underwent DSCT and ICA in turn with the interval time between the two tests less than 3 months. ICA, as the golden standard for diagnosis, was used to evaluate the value of DSCT in the diagnosis of CAD. Results Among 200 patients, 158 were diagnosed as coronary stenosis (luminal stenosis≥50%) by ICA, while 161, as coronary stenosis by DSCT. The sensitivity and specificity of DSCT were 98.1% (155/158) and 85.7% (36/42). Among 2000 coronary segments, 326 were diagnosed as stenosis (luminal stenosis≥50%), while 326, also diagnosed as stenosis by DSCT (P>0.05). The sensitivity and specificity of DSCT were 96.3% (314/326) and 99.3% (1662/1674), respectively. Furthermore, the negative predictive value of DSCT was more than 99%. Conclusion DSCT, with good sensitivity, specificity, and negative predictive value, can be applied to screen CAD in more people, especially for those coronary stenosis without calcification.