双源CT冠状动脉CT血管造影对冠状动脉钙化斑块管腔狭窄的诊断价值  

The value of coronary CT angiography with dual-source CF for the assessment of coronary stenosis due to calcified plaque

作　　者：张也乐[1] 曾祥芹[2] 唐立均 徐怡[1] 朱晓梅[1] 祝因苏[1] 徐海[1] 祁良[1] ZHANG Yele;ZENG Xiangqin;TANG Lijun;XU Yi;ZHU Xiaomei;ZHU Yinsu;XU Hal;QI Liang(Department of Radiology,the First Affiliated Hospital of Nanjing Medical University,Nanjing 210029,China;Department of Radiology,the Central Hospital of Zibo,Zibo,Shandong Province 255000,China)

机构地区：[1]南京医科大学第一附属医院放射科,江苏南京210029 [2]淄博市中心医院放射科,山东淄博255000

出　　处：《实用放射学杂志》2018年第11期1697-1700,共4页Journal of Practical Radiology

摘　　要：目的 探讨双源CT冠状动脉CT血管造影（CCTA）对冠状动脉钙化斑块管腔狭窄的诊断价值。方法 894例怀疑冠状动脉病变患者行双源CT CCTA和冠状动脉造影（CAG）检查。在CCTA图像上，根据冠状动脉管腔横断面钙化斑块区域占管腔周长比率分为4种类型（Ⅰ~Ⅳ型）。以CAG作为金标准，评价CCTA对各种类型钙化斑块管腔狭窄诊断准确性。结果 CCTA对Ⅰ型和Ⅱ型钙化斑块管腔狭窄诊断具有较高的敏感度（96.7%、98.1%）、特异度（99.8%、97.0%）、阳性预测值（95.7%，90.1%）、阴性预测值（99.8%，99.5%）和准确率（99.6%、97.3%）; CCTA对Ⅲ型和Ⅳ型钙化斑块管腔狭窄诊断敏感度（Ⅲ型97.6%、Ⅳ型97.9%）和阴性预测值（Ⅲ型98.3%、Ⅳ型98.7%）较高,而特异度（Ⅲ型78.7%、Ⅳ型67.9%）、阳性预测值（Ⅲ型71.0%、Ⅳ型56.2%）及准确率（Ⅲ型84.9%、Ⅳ型76.8%）明显降低。结论 CCTA对Ⅰ型和Ⅱ型钙化斑块管腔狭窄诊断准确率最高，对Ⅲ型和Ⅳ型钙化斑块管腔狭窄诊断特异度和阳性预测值明显降低。Objective To investigate the diagnostic value of coronary CT angiography （CCTA ） with dual-source CT for the assessment of coronary stenosis due to calcified plaque.Methods 894 patients with suspected coronary artery disease underwent CCTA using dual-source CT and conventional coronary angiography （CAG）. In CCTA images, the calcified plaques were classified into four types （ Ⅰ -Ⅳ） according to the ratio of calcified plaque area to vessel circumference. Diagnostic accuracy of CCTA for various types of calcified plaques was evaluated by using CAG as a standard reference.Results CCTA had high diagnostic performance in sensitivity （96.7%, 98.1%）, specificity （99.8%,97.0%）, PPV （95.7%,90.1%）,NPV （99.8%,99.5%） and accuracy （99.6%,97.3%） for type Ⅰ-Ⅱ calcification,CCTA had high performance in sensitivity （97.6% ,97.9%） and NPV （98.3% ,98.7%） for type Ⅲ -Ⅳ calcification,while remarkable decrease in specificity （78.7%,67.9%）, PPV {71.0%,56.2%） and accuracy （84.9%,76.8%）.Conelusion CCTA has highest accuracy in diagnosing the coronary artery stenosis of type Ⅰ-Ⅱ calcified plaques,but has a significant decrease in specificity, PPV and accuracy in type Ⅲ -Ⅳ calcified plaques.

关 键 词：冠状动脉 冠状动脉钙化 冠状动脉狭窄 计算机体层成像 血管造影术 

分 类 号：R543.3[医药卫生—心血管疾病] R814.42[医药卫生—内科学]