冠脉CT评估不同性质斑块所致狭窄的准确性分析  

Accuracy of coronary computed tomographic angiography in evaluation of coronary stenosis caused by different plaque subtypes

作　　者：张华巍[1] 陈韵岱[1] 孙志军[1] 周迎[1] 田峰[1] 王锦达[1] 朱航[1] 陈思[1] 

机构地区：[1]解放军总医院心内科,北京100853

出　　处：《解放军医学院学报》2016年第10期1043-1045,1049,共4页Academic Journal of Chinese PLA Medical School

基　　金：解放军总医院苗圃基金(13KMM03)

摘　　要：目的探讨冠脉CT评估不同性质斑块引起的管腔狭窄的准确性。方法选取2013年6月-2015年6月本院80例住院行冠脉CT与冠脉造影检查患者的影像资料,共150支血管存在不同程度的病变。根据CT对斑块性质的认定分为非钙化斑块组45支,混合斑块组58支,钙化斑块组57支。以狭窄≥75%作为临界点,分为重度狭窄及非重度狭窄。以冠脉造影为金标准,判断CT诊断的准确性。结果非钙化斑块组,冠脉CT诊断的灵敏度(Se)为95.8%,特异度为(Sp)90.5%,阳性预测值为(PV^+)92%,阴性预测值为(PV^-)95%,诊断准确率为93.3%,Kappa系数为0.866;混合斑块组,冠脉CT诊断灵敏度(Se)为97.5%,特异度(Sp)为83.3%,阳性预测值(PV^+)为93%,阴性预测值为(PV^-)93.75%,诊断准确率为93.1%,Kappa系数0.834;钙化斑块组,冠脉CT诊断灵敏度(Se)为93.3%,特异度(Sp)为37%,阳性预测值(PV^+)为62%,阴性预测值为(PV^-)83.3%,诊断准确率为66.7%,Kappa系数仅为0.313。结论与冠脉造影相比,冠脉CT对于非钙化斑块及混合斑块的判定有较高的准确性,但对钙化斑块的判定准确性不高。Objective To evaluate the diagnostic accuracy of coronary computed tomography angiography（CCTA） on coronary stenosis with different plaque subtypes. Methods From June 2013 to June 2015, 80 patients were admitted for CCTA and coronary angiography in our hospital, and their imaging findings were selected. Totally 150 stenotic vessels were chosen as observation objects. According to CT findings, the plaques types were classified as non-calcified（n=45）, mixed（n=58） and calcified（n=57）. Choosing stenosis greater than 75% as the critical point, they were divided into two groups as severe stenosis and non-severe stenosis. The diagnostic accuracy of CCTA on coronary stenosis was evaluated. Results The sensitivity and specificity of coronary stenosis by CCTA in the non-calcified group were 95.8% and 90.5% with predictive value for a positive result（PV^＋） of 92%, predictive value for a negtive result（PV^-） of 95%, consistency rate of 93.3%, and kappa coefficient of 0.866; The sensitivity and specificity of coronary stenosis by CCTA in the mixed group were 97.5% and 83.3% with PV^＋ of 93%, PV^-of 93.75%, consistency rate of 93.1%, and kappa coefficient of 0.834; The sensitivity and specificity of coronary stenosis by CCTA in the calcified group were 93.3% and 37% with the PV^＋ of 62%, PV^- of 83.3%, consistency rate of 66.7%, and kappa coefficient of 0.313. Conclusion The accuracy of CCTA in detecting non-calcified plaques and mixed plaques of the coronary arteries is high, but it is quite low for the determination of calcified plaque.

关 键 词：冠状动脉粥样硬化 冠脉CT 冠脉造影 

分 类 号：R543.3[医药卫生—心血管疾病]