64排螺旋CT冠状动脉成像对左冠状动脉主干病变的诊断价值  

Diagnostic value of 64-multislice computed tomography for disorders of left main coronary artery

作　　者：沈怡[1] 钱菊英[1] 王明慧[1] 刘媛[1] 刘学波[1] 葛雷[1] 马剑英[1] 葛均波[1] 

机构地区：[1]复旦大学附属中山医院心内科,上海市心血管病研究所,上海200032

出　　处：《上海医学》2009年第12期1060-1066,I0002,共8页Shanghai Medical Journal

基　　金："十一五"国家科技支撑计划(2006BAI01A02);卫生部临床学科重点项目资助

摘　　要：目的比较64排螺旋CT(MSCT)冠状动脉造影(MSCTA)检查与经导管冠状动脉造影(CAG)和血管内超声(IVUS)检查在诊断左冠状动脉主干(LMCA)病变方面的应用价值,探讨MSCTA在LMCA病变诊断中的作用。方法2007年11月—2009年2月在复旦大学附属中山医院心内科临床诊断为冠状动脉性心脏病的住院患者中入选91例,男53例,女38例,平均年龄为(64.8±9.2)岁,均行64排MSCTA、CAG和IVUS检查。以IVUS检查为金标准,比较MSCTA与CAG诊断LMCA病变的敏感度、特异度、阳性预测值、阴性预测值和可靠性。比较MSCTA与IVUS对LMCA病变定量评价的能力。结果以IVUS检查为金标准,CAG诊断LMCA病变的敏感度为25.0%,特异度为100.0%,阳性预测值为100.0%,阴性预测值为26.0%,Kappa值为0.122(P<0.05);MSCTA诊断LMCA病变的敏感度为93.1%,特异度为84.2%,阳性预测值为95.7%,阴性预测值为76.2%,Kappa值为0.744(P<0.001)。MSCTA与IVUS检查测量LMCA病变最小管腔面积(MLA)、外弹力膜面积(EEM-CSA)和斑块负荷的Pearson相关系数(r)分别为0.815、0.740和0.736(P<0.01)。结论以IVUS检查为金标准,MSCTA检查诊断LMCA病变的敏感度和阴性预测值高于CAG检查,MSCTA检查对LMCA病变的定量评价与IVUS检查的相关性良好,能作为LMCA病变的筛查手段。Objective To compare the values of 64-multislice computed tomography coronary angiography （MSCTA）, coronary angiography （CAG）, and intravascular ultrasound （IVUS） in diagnosis of left main coronary artery （LMCA） diseases, so as to assess the role of MSCTA in diagnosis of LMCA diseases. Methods A total of 91 patients （53 males, 38 females, mean age[64.8 ± 9.21 years） were examined by 64- MSCTA, invasive coronary angiography （CAG） and IVUS in our hospital during Dec. 2007 to Feb. 2009. The sensitivities, specificities, positive （PPV） and negative predictive values （NPV） of the MSCTA and CAG in diagnosis of LMCA diseases were compared, with the results of IVUS taken as the gold standard. The quantitative assessment efficiencies of MSCTA and IVUS were also compared. Results The sensitivity, specificity, PPV and NPV of CAG in detecting LMCA diseases were 25.0%, 100.0%, 100.0%, and 26.0%, respectively; Kappa index was 0. 122 （ P〈0. 05）. And those of MSCT were 93.1%, 84.2 %, 95.7 %, and 76.2 %, respectively; the kappa index （K = 0. 744, P〈0. 001） also indicated excellent agreement. The Pearson index between IVUS and MSCT in determining the maximal luminal area, external elastic membrane cross-sectional area, and plaque burden were 0. 815, 0. 740, and 0. 736, respectively （ P〈0. 01 ）. Conclusion Sixty-four section MSCTA is effective in detection of left main coronary artery plaques, with the sensitivity and NPV value higher than that of CAG. The correlation is excellent between the quantitative assessments of MSCTA and IVUS, indicating MSCTA may serve as a tool for LMCA disease screening.

关 键 词：多排螺旋CT 冠状动脉造影 血管内超声 左冠状动脉主干 

分 类 号：R816.2[医药卫生—放射医学]