CT冠状动脉成像与钙化积分结合评价冠心病的价值  

The value of hybrid CT coronary angiography andcalcium score to assess coronary artery disease

作　　者：孙奥松[1] 单守勤[1] 

机构地区：[1]济南军区青岛第一疗养院,山东青岛266071

出　　处：《实用放射学杂志》2014年第3期425-429,444,共6页Journal of Practical Radiology

摘　　要：目的 探讨CT冠状动脉成像（CTCA）、钙化积分（CS）以及二者结合诊断冠状动脉狭窄的准确性。方法 回顾性分析60例行320排容积CT扫描及选择性冠状动脉造影检查（CAG）的影像表现，以CAG为标准，计算CS、CTCA以及2种方法结合诊断冠状动脉狭窄的准确性，CTCA不可评价的节段被认为假阳性。结果 CAG证实有28例134个节段狭窄。CTCA有5例18个节段不可评价，基于个体分析CTCA的敏感性92.9%，特异性81.3%。用CS切点0排除狭窄，CS切点≥400预测狭窄，对CS=0和≥400的患者进行评价，敏感性100.0%，特异性57.1%。用CS和CTCA结合的方法对所有患者进行评价，CS在0~400之间，用CTCA来评价，CS=0和≥400，用CS来评价，敏感性96.4%，特异性81.3%。用CS只评价有不可评价的节段且其他节段无狭窄的患者，敏感性92.9%%，特异性87.5%。结论 320排容积CT诊断冠状动脉狭窄的准确性较高，使用CS和CTCA结合对患者进行评价能够鉴别一部分假阴性、假阳性及不可评价患者。Objective To investigate the accuracy of hybrid CT coronary angiography （CTCA） and calcium score （CS） to diagnose coronary artery stenosis. Methods The retrospective analysis included 60 patients, who underwent CS, CTCA and selective coronary angiography （CAG）. With CAG as the standard reference, the diagnostic accuracy of CS, CTCA, and combination of the two methods were calculated. None evaluable segements were considered as false positive. Results 134 stenostic segments in 28 patients were identified by CAG. On patient-level, the sensitivity and specificity was 92.9% and 81.3% respectively. With CS= 0 to exclude stenosis and ≥400 to predict stenosis, the sensitivity and specificity was 100.0% and 57.1%, respectively. If patients with CS between 0 to 400 were evaluated by CTCA and patients with CS = 0 or ≥400 were investigated with CS, the sensitivity and specificity was 96.4% and 81.3%. If evaluable images were evaluated by CTCA and none-evaluable segments by CS, the sensitivity and specificity was 92.9% and 87.5%. Conclusion Although CTCA has a high accuracy to detect coronary artery stenosis, hybrid CS/ CTCA can further improve the diagnostic performance by correcting some false negative and false positive.

关 键 词：冠状动脉 冠状动脉成像 钙化 钙化积分 

分 类 号：R543.3[医药卫生—心血管疾病] R541.4[医药卫生—内科学]