冠状动脉双源CT与冠状动脉造影成像对急诊胸痛患者诊断冠心病的价值

目的:以常规冠状动脉造影(CAG)为"金标准",探讨急诊胸痛患者双源CT(DSCT)冠状动脉血管成像诊断冠心病的价值,分析DSCT诊断冠心病的准确度、灵敏度、特异度、阳性预测值和阴性预测值。方法:对115例以胸痛为主诉的急诊就诊、临床怀疑冠心病拟行CAG的患者[男60例,女55例,平均年龄(66.37±10.29)岁]进行DSCT冠状动脉成像,统计分析DSCT对诊断冠状动脉不同程度狭窄冠心病的准确度、灵敏度及特异度,并与CAG结果对比。结果:共获得92例有诊断价值的病例,DSCT诊断冠状动脉中重度狭窄的准确度为94.6%,灵敏度、特异度、阳性预测值和阴性预测值分别为96.7%、90.6%、95.1%和93.5%。对于诊断轻度狭窄冠心病的灵敏度为70.6%,特异度为63.9%,阳性预测值为34.3%,阴性预测值为91.2%。结论:DSCT冠状动脉成像可作为临床冠心病可疑患者CAG手术前的预筛手段,当患者的冠状动脉为中重度狭窄时,诊断的准确度、灵敏度、特异度较高,DSCT与CAG有很好的一致性,其对是否需进一步CAG检查有较大的指导意义。DSCT对于冠状动脉轻度狭窄患者的阴性预测值较高,提示如果DSCT判定患者无冠状动脉病变,基本上无进一步行CAG的必要。

Dual-source CT coronary imaging and coronary angiography for diagnosis of coronary heart disease in emergency patients with chest pain

Objective To study the value of dual-source computed tomography(DSCT) for the diagnosis of coronary heart disease(CHD) and compare the accuracy,sensitivity,specificity,positive predictive value and negative predictive value of DSCT with that of conventional coronary angiography(CAG)(served as a gold standard).Methods One hundred and fifteen patients(60 male,55 female,mean age 66.36±10.29) with suspected CHD scheduled for CAG were examined by DSCT 0-8 days prior to CAG.Compared the accuracy,sensitivity and specificity of DSCT with that of CAG for the diagnosis of CHD with various degree of coronary artery stenosis.Results Imaging diagnosis was analyzed for a total of 92 qualified patients.The accuracy of DSCT for the diagnosis of moderate to severe coronary artery stenosis was 94.6%,the sensitivity,specificity,positive predictive value and negative predictive value were 96.7%,90.6%,95.1% and 93.5%,respectively.Meanwhile,the sensitivity,specificity,positive predictive value and negative predictive value of coronary artery slight stenosis were 70.6%,63.9%,34.3%,91.2%,respectively.Conclusions DSCT could be used as a pre-selecting measure for suspected CHD patient before taking CAG.For patients with moderate to severe coronary artery stenosis,the accuracy,sensitivity and specificity are high,and the diagnostic result of DSCT was quite similar to that of CAG.DSCT could be used as a meaningful guidance for deciding whether CAG should be taken.On the other hand,for coronary artery slight stenosis patients,since the negative predictive value of DSCT is quite high,CAG might not be necessary when no coronary artery lesion is seen on DSCT.