64排螺旋CT与选择性冠状动脉造影评价急性冠状动脉综合征患者易损斑块形态、成分及大小的价值对比研究  

Comparative Study on the Value of 64 Slice Spiral CT and Selective Coronary Angiography in Patients with ACS Plaque Morphology,Composition and Size

作　　者：汤艳萍 李令建 

机构地区：[1]新疆维吾尔自治区职业病医院放射科,830000 [2]新疆维吾尔自治区职业病医院神经外科,830000

出　　处：《临床放射学杂志》2016年第8期1181-1185,共5页Journal of Clinical Radiology

基　　金：中华医学会临床医学科研专项资金项目(编号:12020190279);石河子大学医学院第一附属医院院级课题资助项目(编号:YL2011R014)

摘　　要：目的探讨64排螺旋CT评价急性冠状动脉综合征(ACS)患者易损斑块形态、成分及大小的价值。方法65例冠心病患者(其中ACS组32例,稳定性心绞痛组33例)行64排螺旋CT冠状动脉成像及选择性冠状动脉造影。对ACS组及稳定性心绞痛组的管腔狭窄程度、斑块最低密度值、钙化形态(点状钙化或大钙化)及斑块大小进行评价。计算64排MDCT对ACS易损斑块诊断的敏感性、特异性、阳性预测值、阴性预测值。采用SPSS 13.0统计软件进行ACS组与SAP两组之间特征的差异描述和分析,定性变量用卡方检验,定量变量采用两独立样本t检验,P<0.05为差异有显著性。结果两组之间管腔的狭窄程度无差别。ACS组斑块的最低密度CT值[(39±78)HU]低于稳定性心绞痛组斑块的最低密度CT值[(103±114)HU],两组比较差异有统计学意义(P<0.05,t=0.315)。斑块的总体积两组比较无差异,软斑块体积比例>40%的例数,ACS组较稳定性心绞痛组大,差异不具有统计学意义(P>0.05)。点状钙化在ACS组更频繁而稳定性心绞痛组大钙化更为常见,两组比较差异均有统计学意义(P<0.01,t=0.221)。斑块最小密度CT值<35 HU的比例在ACS组较SAP组更频繁(P<0.01,t=0.161)。同时存在点状钙化及斑块最小CT值<35 HU这两个特征对ACS诊断显示很高的阳性预测值,而缺少这两个特征阴性预测值很高。结论 ACS易损斑块CT特征包括:斑块低密度、点状钙化、软斑块体积所占比例较大的特点。冠状动脉粥样斑块同时具有CT值<35 HU、点状钙化特征高度提示斑块的易损性。Objective To assess the morphology,composition and size of vulnerable plaque using 64-detector spiral computed angiography in patients with Acute Coronary Syndrome（ACS） confirmed by coronary angiography.Methods A64-detector spiral CT and coronary angiography was performed for 65 cases of patients with coronary artery disease including32 ACS（acute coronary syndrome） and 33 SAP（stable angina pectoris）.The coronary plaques in ACS and SAP were evaluated for the degree of stenosis,minimum CT density,calcification morphology（spotty or large calcification） and plaque volumes.Furthermore,we calculated the sensitivity,specificity,positive predictive value and negative predictive value of64-detector MDCT for ACS vulnerable plaque diagnostic.Using SPSS 13.0 statistical software,the differences of description and analysis of ACS and SAP（Unstable Angina Pectoris） between the two groups of qualitative variables,using the chi square test for quantitative variables and using two independent samples t-test where P〈0.05 was significant difference.Results Coronary angiography and MDCTA showed no significant differences in the degree of stenosis between the groups.The minimum CT density was significantly lower in patients with ACS（39 ± 78） HU than in those with SA（103 ± 114）HU,P〈0.05,t = 0.315.The total volume of plaque was not significantly different between the groups.Although the lesions associated with ACS had larger total volumes and more frequently of soft plaque volume greater than 40% of the total volume,there was no significantly different（P〈0.05）.Spotty calcification was significantly more frequent in the lesions associated with ACS than SAP,and large calcification（P〈0.01,t = 0.221） was significantly more frequent in the lesions associated with SAP than ACS.The minimum CT density less than 35 HU（P〈0.01,t = 0.161） was significantly more frequent in the ACS lesions.Presence of both（spotty calcification and the minimum CT density 35 HU,） showed a high positive predictive

关 键 词：易损斑块 体层摄影术 X 线计算机 彩色编码技术 

分 类 号：R541.4[医药卫生—心血管疾病] R816.2[医药卫生—内科学]