冠脉严重钙化节段CT减影血管成像技术的临床应用  

Investigation of clinical application for severe segmental calcification by subtraction technique of coronary artery CT angiography

作　　者：过伟锋 曾蒙苏[1,2] 钱菊英[3] 黄浙勇[3] 顾君英[2] 张利军[2] 陆秀良[2] 郭帅 杨姗[1,2] 

机构地区：[1]上海市影像医学研究所,上海200032 [2]复旦大学附属中山医院放射科,上海200032 [3]复旦大学附属中山医院心内科,上海200032 [4]东芝医疗系统(中国)有限公司上海分公司,上海200052

出　　处：《复旦学报（医学版）》2017年第3期274-279,共6页Fudan University Journal of Medical Sciences

基　　金：上海市卫生局科研课题(20124163)~~

摘　　要：目的探讨CT减影冠状动脉血管成像(subtraction coronary computed tomography angiography,SubCCTA)在具有严重钙化节段冠心病中的诊断价值。方法对同时接受320层减影CCTA扫描和传统冠状动脉血管造影(digital subtraction angiography,DSA)检查的27例患者行回顾性分析。对照DSA检查结果,分别计算常规CCTA(conventional CCTA,Con-CCTA)和Sub-CCTA的灵敏度、特异度、阳性预测值、阴性预测值及准确度;采用受试者工作特征(receiver operating characteristic,ROC)曲线评价两种成像方法的临床诊断准确性。冠脉病变节段的狭窄分为Ⅰ、Ⅱ、Ⅲ、Ⅳ4个等级;采用Kappa系数描述两种成像方法与DSA结果之间的一致性。对于剪影前后的图像质量采用4等级评分法,并行t检验对比两者成像质量差异。结果共评估严重钙化节段52个,其图像质量在Con-CCTA和Sub-CCTA中的得分分别为2.8±0.5和3.4±0.7,两者间差异有统计学意义(t=5.9,P<0.05)。Con-CCTA与DSA对定量评估冠脉狭窄程度的一致性为0.55;Sub-CCTA与DSA之间的一致性为0.81。Con-CCTA诊断冠脉明显狭窄的灵敏度、特异度、阳性预测值、阴性预测值及准确度分别为81.0%、63.1%、63.1%、81.1%及70.8%;Sub-CCTA各值分别为90.5%、85.2%、82.1%、92.0%及87.5%。与Con-CCTA的ROC曲线下面积0.84(95%CI:0.70~0.93)相比,Sub-CCTA为0.96(95%CI:0.86~1.00),两者差异有明显统计学意义(P=0.03)。结论 Sub-CCTA可以提高严重钙化节段冠状动脉狭窄程度的诊断准确性;减影技术在冠状动脉成像中的应用可以减少甚至消除严重钙化斑块产生的伪影,具有较好的临床应用前景。Objective To investigate the feasibility of subtraction coronary computed tomography angiography （Sub-CCTA） for the diagnosis of coronary heart disease in the segment with severe calcification. Methods A retrospective analysis was performed on 27 patients who underwent clinically indicated digital subtraction angiography （DSA） and CCTA using a 320-detector rowCT. Compared with the results of DSA, sensitivity, specificity, positive predictive value, negative predictive value and accuracy of Con-CCTA and Sub-CCTA were calculated. The clinical diagnostic accuracy of the two imaging methods was evaluated using the receiver operating characteristic （ROC） curve. The stenosis of coronary segments was divided into four grades （ I , II ,III, IV ）. Kappa coefficient was used to measure agreement between two imaging methods. Image quality of 4-scale grade scoring method was used and t test was conducted. Results A total of 52 segments with severe calcification were evaluated. The scores of image quality in Con-CCTA and Sub-CCTA were 2.8 0.5 and 3.4 ± 0. 7, respectively. There was significant difference between them （t = 5. 9, P〈 0.05）. Compared with the result of DSA as the golden standard, the Kappa coefficients were 0. 55 and 0.81 respectively in Con-CCTA and Sub-CCTA for the quantitative evaluation of the severe calcified segments. The sensitivity, specificity, positive predictive value and negative predictive value and accuracy of Con-CCTA were 81.0%,63. 1%,63. 1%,81. 1% and 70.8%;and for Sub-CCTA they were 90.5% ,85.2% ,82. 1% ,92.0% and 87.5% respectively. Compared with Con-CCTA, the area under the ROC curve of Con-CCTA and Sub-CCTA were 0.84 （95%CI：0.70 - 0.93） and 0.96 （95% CI：0.86 - 1.00） ,respectively,and the difference was statistically significant （P = 0.03）. Conclusions Sub-CCTA can improve the diagnostic accuracy of coronary artery stenosis in severe calcified segment. Application of subtraction technique in CCTA can reduce or even eliminate the artifacts caused by sever

关 键 词：冠心病 CT冠状动脉成像 减影技术 钙化斑块 

分 类 号：R445[医药卫生—影像医学与核医学]