64层螺旋CT检测冠状动脉粥样硬化斑块的初步研究  

A preliminary investigative report of utilizing 64 multi-slice CT coronary angiography in the evaluation of coronary atherosclerotic plaques

作　　者：王焱辉[1] 张兆琪[2] 吕飙[2] 

机构地区：[1]北京市垂杨柳医院放射科,100022 [2]首都医科大学附属北京安贞医院医学影像科,100029

出　　处：《中华放射学杂志》2007年第11期1189-1193,共5页Chinese Journal of Radiology

摘　　要：目的对比冠状动脉内超声(IVUS)检查的结果,评价64层螺旋 CT 冠状动脉成像(MSCTCA)在显示和分析冠状动脉粥样硬化病变方面的可行性和准确性。方法对15例可疑冠心病的患者进行64层 MSCTCA 检查,获取相关的数据,应用后处理技术对冠状动脉粥样斑块进行评估分析,并以3周内实施的 IVUS 结果为金标准进行对比。同时,对2种方法所获得的计量资料(即:血管段某一点的血管腔内面积、血管截面积)进行对比分析,获得直线回归方程(Y:IVUS 值,X:64层MSCT 值)。结果所有病例可用于评估的86个无明显狭窄冠状动脉样本中,IVUS 显示有斑块病变的血管段为38段,64层 MSCTA 显示36段,2段诊断为正常血管。64层 MSCTA 对出现粥样硬化斑块节段诊断的敏感性为94.7%,特异性为100.0%,总符合率为97.7%,误诊率为0,漏诊率为5.3%,阳性预测值100.0%,阴性预测值96.0%。经 Kappa 检验,Kappa 值为0.953,P<0.05。直线回归方程对于2种方法所获得的管腔内面积:Y=0.817+0.832X,P<0.01;血管的截面积:Y=-0.331+1.019X,P<0.01。结论 64层 MSCTCA 在显示冠状动脉粥样硬化斑块病变时,能较为清晰地显示管壁斑块病变的构成情况,对于病变的类型及严重程度的评估比较准确和客观。对于临床怀疑冠心病患者的门诊筛查和初步诊断,具有较好的可行性和准确性。Objective To evaluate the clinical feasibility and accuracy of utilizing 64-detector multi-slice computed tomographic coronary angiography （64-MSCTA） in the evaluation of atherosclerotic plaques as compared to intravascular ultrasound （IVUS）. Methods 64-MSCTA along with post processing was used to examine the left coronary arteries. Independent reviewers evaluated the accuracy of 64-MSCT for presence, composition and distribution of atherosclerotic plaques and remodeling response in comparison to IVUS performed within three weeks, which is regarded as the gold standard. Results Of the 15 patients, there were a total of 86 segments of coronary arteries with atherosclerotic plaques and they were identified and evaluated by IVUS and 64-MSCTA, Thirty-eight lesions were diagnosed with IVUS, 36 lesions were diagnosed with 64-MSCT. Two segments of coronary arteries evaluated by IVUS showed atherosclerotic plaque whereas 64-MSCTA was falsely negative, The sensitivity, specificity, positive predict values,negative predict values, total consistent rate, mistake diagnostic rate and omission diagnostic rate were 94,7%, 100, 0%, 100, 0%, 96, 0%, 97, 7%, 0 and 5, 3% respectively for the detection of plaque, Further statistical analysis using Kappa test showed no significant difference in the detection of plaques between 64-MSCT and IVUS （ Kappa = 0. 953, P = 0.033 〈 0. 05 ）. Measurement data of IVUS and 64-MSCT analyzed with linear regression equation, that showed relationship regarding section area of the vessel and patent lumen obtained with IVUS and 64-MSCT respectively, demonstrated section area of patent lumen： Y =0. 817 ＋0.832X,P 〈 0.01, section area of vessel： Y = - 0.331 ＋ 1. 019X, P 〈 0.01. Conclusions 64-MSCT has excellent sensitivity and specificity in detecting coronary artery plaques, and also can give fairly accurate assessment of presence, composition and distribution of atherosclerotic plaques and remodeling response, Therefore, it is a useful non-invasive method in the clinical evalua

关 键 词：冠状动脉疾病 体层摄影技术 X线计算机 心血管造影术 超声检查 介入性 

分 类 号：R816.2[医药卫生—放射医学]