CT血管成像对冠状动脉分叉病变的诊断价值  

Value of coronary CT angiography in assessment of bifurcation lesions

作　　者：杨筱茜[1] 李佩玲[2] 于海杰[1] 高远[1] 齐国先[1] 

机构地区：[1]中国医科大学附属第一医院心血管内科,沈阳110001 [2]中国医科大学附属第一医院放射科,沈阳110001

出　　处：《中华心血管病杂志》2012年第7期583-588,共6页Chinese Journal of Cardiology

摘　　要：目的评价CT血管成像（CTA）对冠状动脉分叉病变的诊断价值。方法选取先后行冠状动脉CTA及有创性冠状动脉造影检查的疑诊或确诊冠心病患者79例。调取患者的冠状动脉CTA及冠状动脉造影影像资料，选择直径〉2．0mm的2级以上血管分又为研究对象进行回顾性分析。按照冠状动脉分叉病变陈氏分型标准对所有分叉病变进行分型。以冠状动脉造影为金标准，评估冠状动脉CTA对各解剖位置分叉病变的诊断价值（包括敏感度、特异度、阳性预测值和阴性预测值）。通过Spearman等级相关检验和Kappa检验分析两种检查方法对边支血管开口狭窄程度诊断的相关性及初步分型的一致性。结果CTA诊断冠状动脉分叉病变的敏感度、特异度、阳性预测值和阴性预测值分别为94．2％、94．6％、90．7％和96．1％，诊断前三叉、左前降支、后三又病变的敏感度和特异度分别为97．1％和94．2％、95．7％和89．5％、92．3％和98．7％。CTA对边支开口狭窄程度的评估与冠状动脉造影结果相关（r=0．79958，P〈0．01）；两者对分叉病变初步分型（Ⅰ、Ⅱ、Ⅲ型）的结果一致（Kappa系数=0．7959，P〈0．01），对初步分型的亚组分型（a、b、C、d、e亚型）结果也一致（Kappa系数=0．6328，P〈0．01）。结论CTA能够准确诊断冠状动脉分叉病变并对其初步分型，对分叉病变的介入治疗有一定的参考价值。Objective To evaluate the value of coronary CT angiography in assessment of bifurcation lesions. Methods The original image of 79 established and suspected coronary artery disease patients who underwent both coronary CT angiography and conventional artery angiography （CAG） sequentially were included in this analysis. Bifurcation lesions were assessed on primary and secondary vessels with diameter≥2. 0 mm, bifurcation lesions were graded according to Chen＇s classification. CAG was used as golden standard. The sensitivity, specificity, positive predictive value and negative predictive value were calculated. Spearman＇s test and Kappa test were used to evaluate the correlation and classification identity of the two methods. Results CAG evidenced 177 bifurcation lesions out of 445 bifurcation vessels and coronary CT detected 168 bifurcation lesions out of 404 bifurcation vessels with satisfactory imaging quality and 390 bifurcation vessels could he analyzed by both CAG and coronary CT. Sensitivity, specificity, positive predictive value and negative predictive value of coronary CT angiography were 94.2% , 94. 6% , 90. 7% , 96. 1%, respectively. The results for the lesions at LM-LAD/LCX ＋ LAD/Mid, LAD/Diag, RCA/ PDA were more satisfactory and the sensitivity and specificity were as high as： 97. 1% and 94. 2% ,95.7% and 89. 5% ,92. 3% and 98.7% , respectively. There were significant correlations for evaluating the narrow degree of the opening of the bifurcation branch with these two methods （ r = 0. 799 58, P 〈 0. 01 ） and for identifying Ⅰ、Ⅱ、Ⅲ type bifurcation lesions （ Kappa coefficient = 0. 7959, P 〈 0. 01 ） as well as for identifying the subtype bifurcation lesions （ Kappa coefficient = 0. 6328, P 〈 0. 01 ） using the two methods. Conclusion Coronary CT angiography is efficient in identifying the bifurcation lesions and offers a reasonable indication for bifurcation lesion classification.

关 键 词：冠状动脉疾病 体层摄影术 X线计算机 冠状血管造影术 

分 类 号：R816.2[医药卫生—放射医学]