冠状动脉钙化对128层螺旋CT诊断冠状动脉狭窄正确性的影响  

Assessment of the impacts to accuracy of diagnosis by coronary artery calcium using 64-slice spiral computed tomography in patients with coronary atherosclerotic heart disease

作　　者：李效华[1] 樊忠喜[1] 刘斯哲[1] 张超[1] 张茗[1] 于琳琳[1] 刘红伟[1] 岳和全[1] 刘若鹏[1] 孙昊[2] 

机构地区：[1]黑龙江大庆市第四医院,黑龙江大庆163712 [2]首都医科大学附属北京朝阳医院,北京朝阳100020

出　　处：《国际心血管病杂志》2017年第A01期163-164,共2页International Journal of Cardiovascular Disease

摘　　要：目的：探讨128层螺旋CT（MSCT）诊断冠状动脉狭窄的正确性，井分析钙化斑块对诊断正确性的影响。方法：60例患者同期行128层MSCT冠状劝脉扫描和常规冠状动脉连影（CCA）。用MSCT的平扫图像行钙化积分测定．增强图像行二维覆三维重组，以CCA结果为“金标准”，得出128层MSCT诊断有意义病变（直径狭窄率≥50％）的正确性，开分析钙化对诊断正确性的影响。结果：分析797个可以诊断的冠状动脉节段．得出MSCT诊断的敏感性为96％（174／182）．特异性为98％（601/615）．阳性预测值为93％（174／188），阴性预测值为99％（601/609）。对于钙化积分≥100分（Agatston评分）的冠状砷眯节段，MSCT诊断的特异性为63％（12／19）。阳性预测值为81％（30/37）。结论：对于冠状动脉无钙化或者轻度钙化者，128层MSCT可作为诊断冠心病的可靠手段应用于临床。对于严重钙化者．其诊断的特异性和阳性预测值明显下降。Objective ：To investigate the accuracy of detecting coronary artery lesions using a 64-slice spiral computed tomography （MSCT）,and analysis the impacts to diagnosis made by coronary artery calcium. Methods：sixty patients were performed 64-slice spiral CT and conventional coronary angiography （CCA） . Calciumscoring was estimated with plain scans, while 2D and 3D reconstruction were done with enhanced scans. Using CCA as the gold standard,all coronary artery segments were assessed with respect to stenoses ≥ 50% decreased diameter. Results were compared with quantitative coronary angiography （QCA）.The accuracy of 64-slice spiral CT coronary angiography in diagnosing of significant lesions were calculated,and analyzed the impacts to diagnosis by calcifications. Results：A total of 797 segments can be diagnosed.The sensitivity of 64-slice spiral CT for detection of significant lesions was 95% （174 of 182） . Specificity was 98% （ 601 of 615 ） ,positive predictive value 93% （ 174 of 188） ,and negative predictive value 99% （ 601 of 609） .when calcium score≥ 100（Agatston score）, specificity was 63% （ 12 of 19） and positive predictive value was 81% （30 of 37） . Conclusion：The 64-slice spiral CT coronary angiography is a reliable exam of CHD in clinical practice to those people with non- calcification or low calcification .Heavily calcification will degrade specificity and positive predictive value in diagnoses.

关 键 词：体层摄影术 X线计算机 冠状动脉 冠状动脉钙化 

分 类 号：R541.4[医药卫生—心血管疾病]