双源CT与选择性冠状动脉造影对老年患者冠状动脉病变的诊断价值  

Study on the Accuracy of Dual Source Computed Tomography Coronary Angiography in Detection of Coronary Artery Stenoses in Old Patients

作　　者：罗方[1] 刘畅[2] 祝烨[3] 邓珏琳[1] 吴锦晖[1] 丁群芳[1] 张俊[1] 张清琼[1] 

机构地区：[1]四川大学华西医院老年病科,成都610041 [2]四川大学华西医院放射科,成都610041 [3]四川大学华西医院心内科,成都610041

出　　处：《四川大学学报（医学版）》2010年第6期1029-1033,共5页Journal of Sichuan University(Medical Sciences)

摘　　要：目的探讨双源CT(dual source computed tomography,DSCT)冠状动脉扫描对评价60岁以上老年患者冠状动脉病变的临床应用的有效性和准确性。方法选择在2009年7月至2010年6月间于我院就诊的107例60岁以上疑有冠状动脉狭窄的老年患者,对其中102例进行DSCT和选择性冠状动脉造影(selective coronary angiography,SCA)检查。以SCA的结果为金标准,将DSCT的结果与SCA的结果进行比较,评价DSCT对诊断60岁以上老年患者冠状动脉狭窄病变,评价冠状动脉狭窄部位及狭窄程度的敏感性、特异性、阳性预测值、阴性预测值和准确性。结果 102例患者中SCA与DSCT检查出存在中度或中度以上冠状动脉狭窄(狭窄≥50%)的分别为52例和56例。DSCT正确地鉴别出中度或中度以上冠状动脉狭窄患者的敏感性98.1%,特异性90.0%,阳性预测值91.1%,阴性预测值97.8%,准确率94.1%。本研究评估了408支冠状动脉的影像,SCA与DSCT检查发现中度或中度以上冠状动脉狭窄分支的分别为96支和104支。DSCT诊断中度或中度以上冠状动脉狭窄的敏感性95.8%,特异性96.2%,阳性预测值88.5%,阴性预测值98.7%,准确率96.1%。结论 DSCT在老年患者中是一种有效的、能够准确地发现冠状动脉狭窄的检查方法。Objective To investigate the accuracy of dual source computed tomography （DSCT） coronary angiography in detecton of coronary artery stenoses in patients older than 60 years. Methods The study was performed in 102 patients older than 60 years who were suspected of coronary artery stenoses, and without any contraindieations to CT Scan and iodnated contrast agents. These patients underwent DSCT, as well as selective coronary angiography （SCA）. All the data of DSCT were compared with the results of SCA which were regarded as gold standard to assess the sensitivity, specificity, positive predictive value, negative predictive value and accuracy of DSCT in classifying coronary artery stenoses in old patients. Results In these 102 patients, DSCT indicated 56 patients with coronary artery stenoses and SCA indicated 52 patients. DSCT correctly classified 51 patients out of 52 patients who had significant coronary artery stenoses. The sensitivity of DSCT was 98.1%, specificity was 90, 00%, positive predictive value was 91.1%, negative predictive value was 97.8%, and accuracy was 94.1%. DSCT also assessed and measured 408 lesions in all the patients. The sensitivity of DSCT was 95.8%, specificity was 96. 2%, positive predictive value was 88.5 %, negative predictive value was 98.7 %, and accuracy was 96.1 %. Conclusion DSCT appears to be a useful method for the detection of coronary artery stenoses with a high accuracy in elder patients more than 60-year.

关 键 词：冠状动脉狭窄 冠状动脉造影术 计算机成像 双源CT 

分 类 号：R541.4[医药卫生—心血管疾病]