双源CT在冠心病诊断中的价值  

Diagnostic value of dual-source computed tomography in coronary artery disease

作　　者：俞芸[1] 李月华[1] 

机构地区：[1]上海交通大学医学院附属新华医院心内科,上海200092

出　　处：《上海交通大学学报（医学版）》2010年第10期1238-1242,共5页Journal of Shanghai Jiao tong University:Medical Science

摘　　要：目的以侵入性的冠状动脉造影(ICA)为金标准,研究双源CT(DSCT)冠状动脉血管成像在诊断冠状动脉狭窄时的敏感性和特异性,评估其在冠心病筛选中的可行性。方法回顾性分析200例冠心病患者(包括30例心律失常患者)的临床资料。入选患者均先后进行DSCT和ICA检查,两项检查之间间隔不超过3个月。以ICA为金标准,评价DSCT冠状动脉血管成像在诊断冠心病中的诊断价值。结果 200例冠心病患者中,158例经ICA证实存在冠状动脉狭窄(管腔狭窄≥50%),而DSCT冠状动脉血管成像诊断161例,其诊断有意义冠状动脉狭窄的敏感性为98.1%(155/158),特异性为85.7%(36/42)。评估的2 000段冠状动脉中,ICA证实326段存在冠状动脉狭窄(管腔狭窄≥50%),DSCT诊断326段,敏感性为96.3%(314/326),特异性为99.3%(1662/1674)。两者结果间差异均无统计学意义(P>0.05)。并且DSCT对冠状动脉不同程度狭窄的诊断有极高的阴性预测值(均>99%)。结论与ICA相比,DSCT对冠状动脉狭窄,尤其是无钙化的冠状动脉狭窄有较高的敏感性、特异性和极高的阴性预测值,且适用人群大为增加,因此,可以考虑将DSCT冠状动脉成像作为冠心病的筛选手段。Objective With invasive coronary angiography（ICA） as the golden standard for diagnosis,to explore the sensitivity and specificity of dual-source computed tomography（DSCT） in the diagnosis of coronary artery stenosis and to confirm DSCT feasibility in screening coronary artery disease（CAD）. Methods A total of 200 cases of suspected CAD,including 30 cases of arrhythmia,were retrospectively analyzed.The patients underwent DSCT and ICA in turn with the interval time between the two tests less than 3 months.ICA,as the golden standard for diagnosis,was used to evaluate the value of DSCT in the diagnosis of CAD. Results Among 200 patients,158 were diagnosed as coronary stenosis（luminal stenosis≥50%） by ICA,while 161,as coronary stenosis by DSCT.The sensitivity and specificity of DSCT were 98.1%（155/158） and 85.7%（36/42）.Among 2000 coronary segments,326 were diagnosed as stenosis（luminal stenosis≥50%）,while 326,also diagnosed as stenosis by DSCT（P0.05）.The sensitivity and specificity of DSCT were 96.3%（314/326） and 99.3%（1662/1674）,respectively.Furthermore,the negative predictive value of DSCT was more than 99%. Conclusion DSCT,with good sensitivity,specificity,and negative predictive value,can be applied to screen CAD in more people,especially for those coronary stenosis without calcification.

关 键 词：双源CT 侵入性冠状动脉造影 回顾性 

分 类 号：R541.4[医药卫生—心血管疾病]