冠状动脉CTA源图像对非冠脉心脏及血管病变的诊断  

Diagnostic Value of Coronary CTA Source Image on Detecting Extracoronary Cardiac and Vascular Abnormalities

作　　者：全勇 黄德成[1] 李良才[1] 吴任国[1] 何亚奇[1] 李芳云[1] 葛秀云 娄彦平[1] 唐秉航[1] QUAN Yong;HUANG Decheng;LI Liangcai(Department of Radiology, Zhongshan People＇ s Hospital, Guangdong Province 528403, P. R. Chin)

机构地区：[1]广东省中山市人民医院CT室

出　　处：《临床放射学杂志》2018年第5期772-776,共5页Journal of Clinical Radiology

基　　金：广东中山市社会公益科技研究项目(编号:2015B1121)

摘　　要：目的探讨冠状动脉（以下简称冠脉）CTA检查源图像对非冠脉心脏及血管病变的诊断价值。方法搜集2014年1月至2015年12月进行冠状动脉CTA检查的患者2358例,由2名影像专科医师对源图像进行分析,按冠状动脉以外病变发生的部位进行统计,包括心肌、瓣膜、心腔、心包以及扫描范围内的血管病变。冠状动脉病变与冠状动脉以外病变之间的相关性用χ^2检验,并用Kappa检验评价2名医师对于观察有无冠状动脉以外病变的一致性。结果其2213例患者纳入研究,发现371例患者566处非冠脉心脏及血管病变,包括心肌病变43处、心腔病变174处、瓣膜病变161处、心包病变59处、血管病变109处以及20例先天性心脏病,所占比例分别为7.6%、30.7%、28.4%、10.4%、19.3%、3.5%,其中59.6%（221/371）的患者为多部位病变。本组检出59例患者存在危重血管病变,其中51例患者冠状动脉正常或狭窄〈50%,8例患者冠状动脉狭窄≥50%。冠状动脉与冠状动脉以外病变的相关性不高（χ^2=72.50,c=0.145,P〉0.05）。2名医师观察有无冠状动脉以外病变的一致性较好（Kappa值=0.634,P〉0.05）。结论冠状动脉CTA检查源图像对检出扫描范围内的非冠脉心脏及血管病变有其价值,在评估冠状动脉的同时,应重视对源图像的分析。Objective To investigate the diagnostic value of coronary CTA examination source images for non-coronary heart and vascular lesions.Methods A retrospective analysis was performed on 2358 patients who underwent coronaryCTA examination from January 2014 to December 2015.Two image specialists were used to analyze the source images and statistics were taken on the sites of lesions outside the coronary arteries,including the myocardium and the valve.Heart lesions,pericardium,and vascular lesions within the scan range.The correlation between coronary lesions and lesions outside the coronary arteries was examined by χ^2 and Kappa test was used to evaluate the consistency of the two physicians for observing lesions other than the coronary arteries.Results One hundred and forty-five patients were excluded and 2213 patients were included in the study.A total of 566 non-coronary heart and vascular lesions were found in 371 patients.Noncoronary lesions included 43 cases of myocardial lesions,174 cases of heart cavity lesions,161 cases of valve lesions,59 cases of pericardial lesions,109 cases of vascular lesions,and 20 cases of congenital heart diseases,and the proportions were7.6% and 30.7 respectively.%,28.4%,10.4%,19.3%,and 3.5%,of which 59.6%（221/371） were multi-site lesions.Fifty-nine patients in this group were found to have critical vascular lesions,of which 51 had normal or narrow coronary arteries 50% and 8 had coronary artery stenosis ≥50%.The correlation between coronary artery and non-coronary lesions was not high（χ^2= 72.50,c = 0.145,P〈0.05）.Two physicians observed better consistency in the presence of lesions other than the coronary arteries（Kappa = 0.634,P〈0.05）.Conclusion The coronary CTA examination source image is valuable for the detection of non-coronary heart and vascular lesions within the scope of the scan.While assessing coronary arteries,attention should be paid to the interpretation of the source image.

关 键 词：体层摄影术 X线计算机 冠状动脉CTA 非冠脉病变 

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