CT血管造影在诊断功能相关性冠状动脉狭窄中的应用  

Application of CT Angiography in Diagnosing Functional Relevant Coronary Stenoses

作　　者：李剑明[1] 史蓉芳[1] 张立仁[2] 李婷[1] 董智[2] 赵晓斌[1] 徐冬生[2] 

机构地区：[1]天津医科大学心血管病临床学院泰达国际心血管病医院核医学科,天津300457 [2]天津医科大学心血管病临床学院泰达国际心血管病医院放射科,天津300457

出　　处：《中国医学影像学杂志》2012年第9期703-706,710,共5页Chinese Journal of Medical Imaging

基　　金：天津市卫生局科技基金项目(2011KZ12)

摘　　要：目的以SPECT心肌灌注显像(MPI)为参考,评价CT血管造影检测功能相关性冠状动脉狭窄(FRCS)的诊断效能。资料与方法 2005-11～2011-03在天津医科大学心血管病临床学院同期(30d内)行冠状动脉CT血管造影(CCTA)和MPI的504例可疑或确诊冠状动脉疾病患者,以CCTA冠状动脉狭窄≥50%并伴有相应血管支配区域MPI灌注缺损作为诊断FRCS的参考标准。以病例或血管为观察对象,分别计算CCTA冠状动脉狭窄≥50%或≥75%时检测FRCS的诊断效能。结果以病例为观察对象,CCTA冠状动脉狭窄≥50%或≥75%检测FRCS的灵敏度、特异性、阳性预测值和阴性,预测值分别为67.2%和35.8%、84.7%和97.3%、40.2%和66.7%、94.4%和90.8%,差异均有统计学意义(P<0.05);以血管为观察对象,CCTA冠状动脉狭窄≥50%或≥75%检测FRCS的灵敏度、特异性、阳性预测值和阴性预测值分别为70.2%和33.7%、95.4%和99.0%、42.9%和60.0%、98.5%和97.0%,差异均有统计学意义(P<0.05)。结论 CCTA具有较佳的排除FRCS的能力。当冠脉狭窄≥50%时,CCTA虽然对FRCS检测灵敏度较高,但其阳性预测值相对较差。当冠脉狭窄≥75%时,CCTA检测FRCS的阳性预测值有一定的提高。Purpose To investigate and evaluate the diagnostic efficiency of CT angiography in detecting functional relevant coronary stenoses （FRCS） with myocardial perfusion imaging （MPI） as the reference. Materials and Methods 504 patients with suspicious or confirmed coronary artery disease （CAD） underwent coronary CT angiography （CCTA） and MPI in the same period （within 30 days） from November 2005 to March 2011. FRCS was defined when a vessel was narrowing 50% or greater on CCTA and led to corresponding perfusion defect on MPI. The diagnostic efficiency of CCTA for detecting FRCS were calculated when coronary arteries were stenoses equal to or 50% or greater or 75% based on patient or vessel levels, respectively. The diagnostic indexes included sensitivity, specificity, positive predictive value and negative predictive value. Results On patient-based level, the sensitivity, specificity, positive predictive value and negative predictive value for the vessel narrowing 50% or greater or 75% or greater on CCTA were 67.2% and 35.8%, 84.7% and 97.3%, 40.2% and 66.7%, 94.4% and 90.8%, respectively. The differences were statistically significant （P 〈 0.05）. On vessel-based level, the sensitivity, specificity, positive predictive value and negative predictive value for the vessel narrowing 50% or greater or75% or greater on CCTA were 70.2% and 33.7%, 95.4% and 99.0%, 42.9% and 60.0%, 98.5% and 97.0%, respectively. The differences were statistically significant （P〈0.05）. Conclusion CCTA is able to rule out FRCS. Although CCTA has relatively high diagnostic sensitivity when the coronary stenoses is 50% or greater, its positive predictive value for detecting FRCS is relatively low. Positive predictive value for detecting FRCS can be improved when the coronary stenoses is 75% or greater on CCTA.

关 键 词：体层摄影术 X线计算机 冠状动脉疾病 心肌灌注显像 体层摄影术 发射型计算机 单光子 功能相关性冠状动脉狭窄 

分 类 号：R543.31[医药卫生—心血管疾病] R445.3[医药卫生—内科学]