双源CT对主动脉瓣狭窄的诊断价值  

Assessment of aortic stenosis with dual-source CT

作　　者：王朴飞[1] 吕梁[1] 王罡[1] 杨利鹏[1] 余波[1] 安鸿飞[1] 周子煜[1] 

机构地区：[1]云南省第一人民医院放射科,昆明650032

出　　处：《中华放射学杂志》2014年第6期476-479,共4页Chinese Journal of Radiology

摘　　要：目的：以经胸心脏超声（TTE）为对照，探讨双源CT（DSCT）评估主动脉瓣狭窄（AS）的可行性及准确性。方法回顾性分析53例行DSCT冠状动脉成像及TTE检查，经TTE诊断均为AS的患者。 DSCT面积法测量收缩期最大主动脉瓣口面积（AVA），TTE采用连续性方程计算AVA值。根据测量的AVA值，将AS分为轻度、中度及重度狭窄。采用Pearson相关分析及Bland-Altman法分析DSCT与TTE测量AVA相关性及一致性。采用Kappa分析2种方法评估AS狭窄程度一致性。结果 DSCT测量AVA值为（1.45±0.35）cm2，TTE所得AVA值为（1.33±0.36 cm）2，2种方法所测AVA值间具有明显相关性（r＝0.92，P＜0.01），Bland-Altman分析显示2种检查方法测量AVA值一致性较好，但DSCT所测AVA值略高于TTE。53例AS患者经TTE证实，轻度狭窄13例、中度狭窄21例、重度狭窄19例；其中3例患者TTE诊断为轻度狭窄，而DSCT诊断为阴性；6例DSCT评估为轻度狭窄，而TTE 证实为中度狭窄。 Kappa 分析示2种方法检测主动脉瓣狭窄程度一致性较好（ Kappa＝0.75，P＜0.01）。结论 DSCT测量AS患者AVA是可行的，可对中、重度AS进行准确评估。Objective To discuss the feasibility and accuracy of dual-source CT （ DSCT） in the evaluation of aortic stenosis （ AS） with transthoracic echocardiography （ TTE） as reference.Methods A total of 53 patients who underwent both DSCT and TTE were prospectively evaluated.All of them were assessed by TTE for aortic stenosis.Maximum aortic valve area （ AVA） in systolic phase was measured with DSCT , and was compared to that index obtained from the continuity equation on TTE.The severity of AS was graded as mild , moderate , or severe according to the AVA.Linear regression analysis and Bland-Altman plots were used to compare the AVA measured by using CT and TTE.Agreement on semi-quantitative grades of AS severity between the two methods was tested by using Kappa statistics.Results The mean AVA using DSCT was （1.45 ±0.35 ） cm2 compared to the mean AVA of （ 1.33 ±0.36 ） cm2 using TTE, with a significant correlation between them （r=0.92,P〈0.01）.Bland-Altman analysis demonstrated good inter-modality consistency between DSCT and TTE.However , DSCT demonstrated a slight overestimation of the AVA compared to TTE.As identified by TTE, there were 53 patients with AS, 13 with mild AS, 21 with moderate AS , and 19 with severe AS.In 3 patients DSCT showed no AS , TTE detected mild AS.In 6 cases, TTE had graded the stenosis as moderate , but the stenosis degree was graded as mild using DSCT.Kappa analysis showed a good agreement between the two methods on semi -quantitative grades of aortic stenosis severity （Kappa=0.75,P〈0.01）.Conclusion AVA measurements using DSCT is feasible and reasonably accurate for those patients with moderate to severe aortic stenosis.

关 键 词：主动脉瓣狭窄 体层摄影术 X线计算机 超声心动描记术 

分 类 号：R816.2[医药卫生—放射医学] R542.5[医药卫生—临床医学]