冠状动脉钙化对320排容积CT冠状动脉血管成像的影响  

Influence of coronary artery calcification on 320-detector volume CT coronary angiography

作　　者：孙奥松[1] 孙钢[1] 李敏[1] 彭兆辉[1] 

机构地区：[1]第二军医大学济南临床医学院医学影像科,山东省250031

出　　处：《中华临床医师杂志（电子版）》2013年第2期51-54,共4页Chinese Journal of Clinicians(Electronic Edition)

摘　　要：目的探讨320排容积CT(DVCT)冠状动脉钙化(CAC)对冠状动脉图像质量及诊断准确性的影响。方法回顾性分析济南军区总医院2011年12月至2012年3月行DVCT扫描及常规冠状动脉造影检查(ICA)的患者60例,计算每例患者总的钙化积分(CS)及四大分支的CS,以图像质量4级(优)至1级(差)对每支血管图像质量进行评价,分析患者每支血管的CS与图像质量的相关性。对患者及每支冠状动脉血管的明显狭窄(狭窄≥50%)进行判断,以ICA为金标准,作出该60例患者冠状动脉狭窄≥50%的ROC曲线,获得患者总CS的最佳截断点。以最佳截断点为界,将60例患者分为高CS组和低CS组,以每支冠状动脉为研究对象,不可评价的血管作为假阳性处理,对高、低CS组的诊断准确性进行比较,同时比较两组DVCT冠状动脉成像结果与ICA结果的差异性,分析CS对冠心病诊断准确性的影响。结果冠状动脉钙化积分(CACS)与图像质量呈负相关,CS越高,图像质量越差。该60例患者的冠状动脉狭窄≥50%的ROC曲线的CS最佳截断点为381.5分(灵敏度为81.5%,特异度为78.8%)。高CS组的诊断准确性低于低CS组(P=0.009),而两组DVCT结果与ICA结果的差异均无统计学意义(P=0.134,0.607)。结论 CAC仍是320排容积CT图像质量及诊断准确性下降的重要原因。Objective To investigate the impact of coronary artery calcification （CAC） on image quality and diagnostic accuracy of 320-detector volume CT（DVCT）. Methods 60 patients who underwent DVCT coronary angiography and invasive coronary angiography（ICA） from December 2011 to March 2012 were included. The total calcium score （CS） of each patient and the CS of the four branches were calculated. The image quality of each vessel was scored from 4 （excellent） to 1 （bad）. The correlation between the CS and image quality was analyzed. With ICA as the standard reference, significant stenosis （stenosis ~〉 50% ） of CT angiography was judged. The optimal cut-off point of the total CS to predict coronary stenosis I〉 50% was investigated by depicting the ROC curve. According to the cut-off point,60 patients were divided into the high-CS group and the low-CS group. We compared the diagnostic accuracy of high and low CS group, with ICA as standard reference. On artery-level, not-evaluative vasculars were considered false positive. The impact of CS on diagnostic accuracy of coronary heart disease was analyzed. Results CACS and the image quality were inversely correlated. The optimal cut-off point of the 60 patients was set at 381.5 （sensitivity 81.5% and specificity 78. 8% ）. Though the differences of the two groups between DVCT and ICA was both not significant （P = 0. 134, P = 0. 607）, the diagnostic accuracy of high-CS group was lower than the low-CS （P = 0. 009）. Conclusions CAC is still an important reason for the decline of image quality and accuracy of 320-detector volume CT.

关 键 词：冠状动脉疾病 体层摄影术 螺旋计算机 冠状血管造影术 钙化积分 

分 类 号：R816.2[医药卫生—放射医学]