64层螺旋CT评价冠状动脉狭窄的敏感性和准确性研究

目的评价64层螺旋CT冠状动脉成像（64SCTCA）对探测冠状动脉狭窄的敏感性和准确性。方法搜集36例患者64SCTCA的完整资料,并以近期实施的冠状动脉成像（CAG）结果为金标准进行对比,对64层螺旋CT冠状动脉主干及分支进行分析评估。结果所有病例可用于评估的342支中,共显示病变166支,其中134支得到证实;32支64SCTCA诊断存在病变而CAG显示正常;10支CAG确诊的病变在64SCTCA未能显示。64SCTCA显示冠状动脉病变的敏感性为80.7%,特异性94.3%,准确性为87.7%,阳性预测值93.0%,阴性预测值83.8%。采用成组配对χ2检验,P=0.05,证明64SCTCA和CAG两种检查方法在确诊冠状动脉病变上差异没有统计学意义。在对不同程度病变的评估上,轻度狭窄的敏感性为85.7%,准确性为83.0%;中度狭窄的敏感性为96.9%,准确性为98.5%;重度狭窄的敏感性为91.4%,准确性为95.9%。结论 64SCTCA在评价不同程度的冠状动脉狭窄时,具有较高的敏感性和准确性,因而它适用于冠心病的前期筛查及诊断。

A research into the sensitivity and accuracy of 64 SCTCA for visualizing coronary artery stenoses

Objective To evaluate the sensitivity and accuracy of 64 slice spiral computed tomography coronary angiography（64 SCTCA） for visualizing coronary artery stenoses. Methods Thirty-six patients with clinically suspected coronary artery diseases underwent 64 SCTCA examinations. The stenotic degrees of coronary artery trunk and branches in all patients were evaluated by using 64 SCTCA and compared with invasive coronary angiography（CAG） . Results Among 342 assessable branches of all patients,166 branches were found to have lesions on CAG,of them,134 branches were identified by 64 SCTCA. 10 false-positive and 32 false-negative branches were found on 64 SCTCA. The sensitivity,specificity,accuracy,positive predictive value,and negative predictive value of 64 SCTCA for visualizing the coronary artery lesions were 80.7%,94.3%,87.7%,93.0%,and 83.8%,respectively. Statistical analysis was performed with the chi-square test and a P value=0.05 was not significantly different between 64 SCTCA and CAG in identifying the corouary artery lesions. Compared with CAG,the sensitivity and accuracy of 64 SCTCA for mild stenosis were 85.7% and 83.0%,for middle stenosis were 96.9% and 98.5%,for severe stenosis were 91.4% and 95.9%. Conclusion 64 SCTCA in evaluating different degrees of coronary artery stenoses has higher sensitivity and accuracy so that it may be used for previous screen and diagnosis of this disease.