双源CT与血管内超声对冠状动脉临界病变的评估及其与最小管腔面积关系的对比研究  

Assessment of Coronary Plaque of Borderline Lesion and Relationship between Plaque Features and the Minimal Lumen Area with Dual-source Computed Tomography：Comparison with Intravascular Ultrasound

作　　者：张文瑾[1] 沈比先[1] 彭珂文[1] 李元歌[1] 陈少源[2] 

机构地区：[1]广东医学院附属南山医院放射科,广东深圳518052 [2]广东医学院附属南山医院心内科,广东深圳518052

出　　处：《实用放射学杂志》2011年第4期508-513,共6页Journal of Practical Radiology

摘　　要：目的 以血管内超声（intravascular ultrasound,IVUS）为标准,评价双源CT血管成像（dual source computed tomography angiography,DSCTA）对临界病变的诊断价值.方法 收集19例病人经冠状动脉造影（coronary angiography,CAG）证实的临界病变,按照临界病变斑块处最小管腔面积（MLA）（MLA≤4 mm2和左主干≤6 mm2或者大于此值）值分A组和B组,统计分析A、B 2组的分布差异,评估DSCTA在斑块定量检测、定性分析方面的价值,评价DSCTA检出临界病变A组的准确性.结果 IVUS共检出临界病变44个,A组25个、B组19个,斑块负荷（PB）在A组和B组分别是75.72%±5.17%、65.42%±8.56%,2组间有显著性差异（P＜0.001）,且A组内多为软斑块（P＝0.0158）.DSCTA检出临界病变A组的敏感度、特异度、准确度、阳性预测值、阴性预测值分别为82.6%,88%,85%,90%,79%.DSCTA和IVUS对平均MLA、平均血管外膜面积（external elastic membrane cross sectional area,EEM CSA）、平均斑块面积（plaque cross section area,plaqueGAAB2CSA）、平均PB 的相关系数分别为 r=0.888 、r = 0.824、r=0.761、r=0.747.DSCTA 发现40个斑块,软斑块9例,纤维斑块12例,混合斑块19例,其中纤维-脂质斑块11例,钙化-纤维斑块4例,钙化-脂质斑块4例,纤维-脂质斑块与纤维斑块无统计学差异;钙化-脂质斑块与钙化-纤维斑块无统计学差异.结论 DSCTA对于检出MLA≤4 mm2处斑块具有较好的诊断价值;斑块定量与IVUS具有良好的相关性,可作为一种无创、准确检测临界病变的首选方法.Objective To explore the value of dual source computed tomography angiography （DSCTA） in diagnosing borderline lesion and plaque characteristics. Methods 19 patients with coronary borderline disorder confirmed by CTA underwent both DSCTA and intravascular uhrasound（IVUS）. All case were divided into two groups according to minimal lumen area （MLA）at narrow re gions：group A ≤ 4mm2 （left main ≤ 6mm2 ） and B〉 4mm2 （left main〉 6mm2 ） The external elastic membrane cross sectional ar ea （EEMCSA） ,MLA,plaque area and plaque burden（PB） were evaluated with DSCTA . Results 44 plaques were found by IVUS, including 25 in A and 19 in B. Plaque burdens （PB） were（75.72±5.17）% in group A and（65.42±8.56）% in group B, there was significant different between group A and B （P〈0. 001） and soft plaques were most seen in group A（P=0. 0158）. The sensitivity , specificity , accuracy and positive predictive value were 82. 6%, 88%, 85%, 90% and 79%, respectively in detecting plaques by DSCTA. The correlation coefficients for the measurements of the MLA, EEMCSA ,PA, and PB were r = 0. 888 , r=0. 824 , r = 0. 761 and r=0. 747,respectively. The mean CT values for soft plaque （n=9）, fibrous（n=12）, mixed （n-=19）, including fiber-lipid（n=11）, calcification fibrous （n=4）, calcification-fatty （n=4） were（57.19±7. 55）HU,（97. 7±18）HU,（96. 05±17）HU, （153.1 ±7.51）HU, （165± 52.3）HU,respectively. CT values were not significantly different between fiber-fatty and fibrous （ P =0.74 ） and between calcification-lipid and calcification-fibrous （P= 1.00 ） also . Conclusion DSCTA is a noninvasive modality that is obviously relative to IVUS in quantification of coronary artery plaques of borderline lesion , and DSCTA has a clinical value in detecting the plaques at MLA regions , which can be a firstchoice to determine borderline lesion accurately and non-invasion.

关 键 词：心脏 冠状动脉 超声 体层摄影术 X线计算机 

分 类 号：R543.1[医药卫生—心血管疾病] R445.1[医药卫生—内科学]