双源CT与冠状动脉血管内超声评估冠状动脉粥样硬化斑块价值的对照研究  

Comparison of the values of dual-source CT with intravascular ultrasound to evaluating coronary atherosclerotic plaques

作　　者：李岳军 闫继锋[2] 

机构地区：[1]汝州市第一人民医院心内科,河南汝州467500 [2]河南省胸科医院心内科,郑州450000

出　　处：《中华实用诊断与治疗杂志》2016年第5期463-466,共4页Journal of Chinese Practical Diagnosis and Therapy

基　　金：2010河南省医学科技公关项目(201002022)

摘　　要：目的探讨双源CT(dual-source CT,DSCT)、冠状动脉血管内超声(intravascular ultrasound,IVUS)在冠状动脉粥样硬化斑块性质、血管重塑评估中的应用价值。方法冠心病患者31例,均于入院后先行DSCT,并于行冠状动脉造影(coronary angiography,CAG)同时行IVUS检查,判定斑块性质,测量狭窄处血管横断面积、血管管腔面积、斑块面积、面积狭窄率、血管重构指数,并进行比较。结果对31例患者36支血管(左前降支18支、左回旋支9支、右冠状动脉9支)的75个节段进行了检测,在发现病变的55个节段中,选择其中48个斑块进行统计分析;DSCT检出软斑块17个,纤维型斑块11个,钙化斑块8个,混合斑块12个;IVUS检出软斑块17个,纤维型斑块12个,钙化斑块8个,混合斑块11个,2种方法在判定斑块性质上比较差异无统计学意义(P>0.05);DSCT检出负性重构节段8个,无重构节段29个,正性重构节段11个,斑块偏心指数为(0.50±0.06)%;IVUS检出负性重构节段6个,无重构节段33个,正性重构节段9个,斑块偏心指数为(0.53±0.08)%,2种方法比较差异无统计学意义(P>0.05);DSCT测量狭窄处血管横断面积[(17.50±2.33)mm^2]、血管管腔面积[(8.99±0.85)mm^2]、斑块面积[(7.47±1.28)mm^2]、面积狭窄率[(55.90±10.01)%]、血管重构指数[(1.04±0.12)%]与IVUS测量结果[(16.95±2.55)mm^2、(8.52±0.89)mm2、(8.45±1.77)mm2、(64.85±11.10)%、(1.06±0.15)%]比较差异无统计学意义(P>0.05);以IVUS检测结果为标准,DSCT检测斑块的敏感性、特异性、阳性预测值、阴性预测值分别为95.8%、85.2%、92.0%、92.0%。结论 DSCT在冠状动脉粥样硬化斑块定性、定量分析及血管重塑评价中有较高价值,是一种无创的筛查冠心病的方法。Objective To explore the values of dual-source CT （DSCT） and intravascular ultrasound （IVUS） to evaluating coronary atherosclerotic plaques and artery remodeling. Methods Thirty-one patients with suspected coronary heart disease received DSCT after admission followed by IVUS during coronary angiography to assess the plaque nature and to measure and compare the coronary artery transverse area, lumen area, plaques area, area stenotic degree and artery remodeling index at stenosis site. Results In 75 segments in 36 vessels from 31 patients （18 left anterior descending branches, 9 left circumflex branches and 9 right coronary branches）, 55 segments were found lesions, in which 48 plaques were statistically analyzed. DSCT displayed 17 soft plaques, 11 fibrous plaques, 8 calcified plaques and 12 mixed plaques, and IVUS showed 17 soft plaques, 12 fibrous plaques, 8 calcified plaques and 11 mixed plaques, with no significant differences between two methods （P〉 0.05）. DSCT displayed 8 negative remodeling segments, 29 non-remodeling segments and 11 positive remodeling segments, with the eccentric index of （0.50±0.06）%, and IVUS showed 6 negative remodeling segments, 33 non-remodeling segments and 9 positive remodeling segments, with the eccentric index of （0.53±0. 08）%, showing no significant differences between two methods （P〉0. 05）. There were no significant differences in the coronary artery transverse areas （（17.50±2.33）, （16.95±2.55） mm^2） , lumen areas （（8.99±0.85）, （8.52±0.89） mm^2）, plaques areas （（7.47±1.28）, （8.45±1.77） mm^2）, area stenotic degrees （（55.90±10.01）%, （1.06±0.15） -） and artery remodeling indexes （（1.04±0.12） %, （0.53±0.08） %） at stenosis site between DSCT and IVUS （P〉0.05）. Regarding IVUS results as the standard, the sensitivity of DSCT was 95.8%, specificity was 85.2%, positive predictive value was 92.0% and negative predictive value was 92.0%. Conclusion DSCT has a high value to the qualit

关 键 词：冠心病 冠状动脉粥样硬化斑块 血管重塑 双源CT 冠状动脉血管内超声 

分 类 号：R541.4[医药卫生—心血管疾病]