64层螺旋CT冠状动脉钙化积分的再认识  

Re-consideration of 64-row Multi-slice Spiral Computed Tomography Coronary Artery Calcium Scoring

作　　者：鲁锦国[1] 吕滨[1] 戴汝平[1] 蒋世良[1] 唐翔[1] 吴文辉[1] 宋会军[1] 乔树宾[2] 

机构地区：[1]北京协和医科大学,中国医学科学院阜外心血管病医院放射科,北京100037 [2]北京协和医科大学,中国医学科学院阜外心血管病医院心内科,北京100037

出　　处：《放射学实践》2009年第8期854-858,共5页Radiologic Practice

基　　金：国家自然科学基金青年基金项目(30200067)

摘　　要：目的:研究64层螺旋CT(64-MSCT)冠状动脉钙化积分(CACS)与冠状动脉狭窄间的关系,初步探讨诊断冠状动脉狭窄的钙化积分的合适切点(OCP)。方法:对150例同期行常规冠状动脉成像(CAG)和64层螺旋CT冠状动脉成像(CTA)的连续患者进行回顾性分析,定量评价钙化积分与冠状动脉狭窄的关系。结果:患者钙化积分与年龄、狭窄程度及病变支数均成正相关(r=0.41、0.37、0.41,P<0.001)。对患者、分支、节段冠状动脉狭窄≥50%的诊断,ROC曲线下面积分别为0.78、0.76、0.67,对狭窄≥70%的诊断,ROC曲线下面积分别为0.76、0.75、0.66。依据ROC曲线获得诊断患者冠状动脉狭窄≥50%、≥70%的钙化积分切点为255分、374分(特异度均为95%,敏感度分别为42.2%和39.4%)。结论:钙化积分可反映冠状动脉病变的程度及范围,对患者或每支冠状动脉狭窄有较高的诊断准确性。对于冠状动脉大量钙化患者,钙化积分可作为传统冠状动脉造影前的筛查手段或辅助CTA诊断。Objective：To investigate the relationship of coronary artery calcium score （CACS） and angiographic coro- nary artery stenosis and to find the appropriate operating point of CACS for diagnosing the likely severity of coronary artery stenosis. Methods： One hundred and fifty consecutive patients suspected of having coronary artery disease were scheduled to undergo electrocardiographically gated 64-row multi-slice spiral computed tomography （64-MSCT） coronary angiography （CTA） and conventional coronary angiography （CAG）. CACS was calculated using Agatston＇s method. The relation be- tween CACS and coronary artery stenosis was evaluated. Results：The results showed that there was respectively the positive relation between CACS and age,severity of coronary artery stenosis and number of diseased vessels, the relative coefficient （r） was 0.41, 0.37, 0.41 respectively. When the coronary artery stenosis of every segment was diagnosed to be ≥50%, the areas under ROC curve were 0. 78.0. 76.0. 67 respectively,and when the coronary artery stenosis was ≥70% ,the areas under ROC curve were 0. 76.0. 75.0. 66 respectively. We plotted ROC curves to determine optimal coronary calcium scoring cut points. CACS was 255 when diagnosing the coronary arteries stenosis to be ≥50% with the specificity and sensitivity being 95% and 42.2%, respectively, and 374 when diagnosing the coronary arteries stenosis to be ≥70% with the specifici- ty and sensitivity being 95 % and 39.4 %, respectively. Conclusion：The CACS detected by 64-MSCT can display the severity and extent of the coronary artery stenosis and has a high accuracy for diagnosing coronary artery stenosis of every patient or every branch. To the patients with high calcium score,CACS can be used as a tool to screen severe coronary heart disease or combined with CTA to improve accuracy for the diagnosis of coronary artery stenosis.

关 键 词：体层摄影术 X线计算机 冠状动脉钙化 冠状动脉狭窄 

分 类 号：R816.2[医药卫生—放射医学]