零钙化积分冠状动脉CTA表现分析  

CT coronary angiographic findings in patients with zero coronary calcium scores

作　　者：张树清[1,2] 崔磊[1,3] 黄胜[1,3] 盛臻强[1,2] 王毅[1,2] 盛美红[1,3] 

机构地区：[1]南通大学第二附属医院 [2]南通市第一人民医院心内科,江苏南通226001 [3]南通市第一人民医院影像科,江苏南通226001

出　　处：《中国医学影像技术》2011年第11期2222-2226,共5页Chinese Journal of Medical Imaging Technology

基　　金：南通市科技局社会发展科技计划项目(S2008034)

摘　　要：目的分析零冠状动脉钙化积分(CACS)患者64层冠状动脉CTA(CTCA)表现,并评估诊断准确率。方法对328例零CACS的疑似冠心病患者,分析CTCA表现,包括有无狭窄、斑块形态、位置和狭窄程度。其中69例有传统冠状动脉造影结果,计算零CACS患者CTCA诊断狭窄≥70%的敏感度、特异度、准确度、阳性预测值和阴性预测值。结果 328例零CACS患者,CTCA示37例(37/328,11.28%)存在不同程度的狭窄和斑块,无或轻度狭窄26例(26/37,70.27%),中度狭窄8例(8/37,21.62%),重度狭窄3例(3/37,8.11%)。54个狭窄斑块包括软斑块39个(39/54,72.22%)、混合斑块8个(8/54,14.81%)及7个钙化斑块(7/54,12.96%)。基于病例(69例)和基于冠状动脉节段(997个节段)CTCA诊断狭窄≥70%的敏感度、特异度、准确率、阳性预测值和阴性预测值分别为97.14%(34/35)、94.12%(32/34)、95.65%(66/69)、94.44%(34/36)、96.97%(32/33)和94.23%(49/52)、99.58%(941/945)、99.30%(990/997)、92.45%(49/53)、99.68%(941/944)。结论 CTCA可显示零CACS患者冠状动脉的不同程度狭窄和斑块,且诊断准确度较高。Objective To evaluate the findings and the diagnostic accuracy of 64-slice CT coronary angiography （CTCA） for the detection of significant coronary artery stenosis in patients with zero coronary calcium score （CACS）. Methods Totally 328 patients with suspected coronary artery disease with a zero CACS were retrospectively identified. CTCA studies were assessed for the presence, morphology, location and severity of all coronary plaques. Compared to conventional coro nary angiography, the sensitivity, specificity, accuracy, positive and negative predictive value of CTCA in diagnosing ste nosis ≥70% were calculated in 69 patients. Results CTCA showed different stenosis and plaques in 37 of 328 patients with a zero CACS （37/328, 11.28%）. Normal or mild stenosis was presented in 26 （26/37, 70.27%） patients, moderate stenosis in 8 （8/37, 21. 62%） and severe stenosis in 3 （3/37, 8.11%）. Among the 54 plaques, 39 （39/54, 72.22%） were identified as non-calcified, 8 （8/54, 14.81%） were of mixed morphology, and 7 （7/54, 12.96%） were calcified. The sen sitivity, specificity, accuracy rate, positive and negative predictive value of CTCA on the patient level was 97.14 % （34/ 35）, 94.12% （32/34）, 95.65% （66/69）, 94.44% （34/36） and 96.97% （32/33） respectively, while on the segment level was 94.23% （49/52）, 99.58% （941/945）, 99.30% （990/997）, 92.45% （49/53） and 99.68% （941/944）, respectively. Conclusion CTCA can display different coronary stenosis and plaques in patients without coronary calcification with high accuracy rate.

关 键 词：冠状动脉疾病 冠状动脉狭窄 冠状动脉钙化积分 冠状血管造影术 

分 类 号：R814.42[医药卫生—影像医学与核医学] R543.3[医药卫生—放射医学]