冠状动脉CT血管成像斑块主要成分定量分析对斑块类型的鉴别价值  

Quantitative analysis of main components by coronary CT angiogram of coronary artery plaques

作　　者：姚易明 叶靖[2] 高慧 郭晓丽 王丽娟 吴晶涛[2] YAO Yi-ming;YE Jing;GAO Hui(Dalian Medical University,Dalian 116044,China)

机构地区：[1]大连医科大学,大连116044 [2]江苏省苏北人民医院,扬州225001

出　　处：《放射学实践》2019年第7期767-773,共7页Radiologic Practice

摘　　要：目的:探讨冠状动脉CT血管成像(CCTA)斑块定量分析技术在不稳定性心绞痛(UAP)和稳定性心绞痛(SAP)患者的易损性斑块、稳定性斑块主要成分定量中的价值。方法:回顾性连续搜集并分析41例心绞痛患者(UAP18例、SAP23例)的320排CT冠状动脉成像(CTA)和冠状动脉造影(CAG)检查结果,并将斑块分为UAP易损性斑块(Ⅰ组)、UAP稳定性斑块(Ⅱ组)和SAP稳定性斑块(Ⅲ)。三组斑块节段内脂质、纤维、钙化的体积及体积百分比差异的比较采用单因素方差分析,之后的两两比较采用LSD检验。采用受试者操作特征(ROC)曲线分析诊断易损性斑块与所有稳定性斑块较好指标的诊断阈值,并计算其对应的敏感度、特异度、阳性预测值(PPV)和阴性预测值(NPV)。结果:共45个斑块进行定量分析研究,Ⅰ组、Ⅱ组、Ⅲ组分别为10个、9个、26个斑块。易损性斑块与两组稳定性斑块在脂质(49.3%±4.1%vs31.8%±6.3%、33.4%±6.9%)和钙化(2.9%±2.7%vs13.0%±11.8%、17.2%±10.8%)百分比差异均具有统计学意义(P<0.05),脂质百分比易损性斑块高于稳定性斑块,钙化百分比易损性斑块低于稳定性斑块。易损性斑块与UAP稳定性斑块在纤维体积(47.5±14.4vs74.7±37.5)差异具有统计学意义(P<0.05)。两组稳定性斑块在脂质(31.8%±6.3%vs33.4%±6.9%)和钙化(13.0%±11.8%vs17.2%±10.8%)百分比上差异均无统计学意义(P>0.05)。诊断易损性斑块各项指标中,脂质百分比的ROC曲线下面积(AUC)较高,为0.994,其对应的脂质体积AUC为0.811,基于脂质百分比ROC曲线判断易损性斑块与稳定性斑块的分界点为44.1%,其对应的敏感度、特异度、PPV和NPV分别为100%、88.5%、71.4%、100%。此外,纤维体积和纤维百分比、钙化体积和钙化百分比仅有低或无诊断价值。结论:CCTA斑块定量分析技术可测量冠状动脉斑块主要成分,为临床提供鉴别斑块类型的依据。Objective: To explore the value of coronary CT angiography (CCTA)-based plaque quantitative analysis in the quantification of vulnerable plaques and stable plaques in patients with unstable angina (UAP) and stable angina (SAP). Methods: Data of 320-row CT coronary angiography (CTA) and coronary angiography (CAG) from 41 patients with angina pectoris (UAP18 and SAP23) were retrospectively and continuously collected and analyzed.Plaques were divided into three groups:UAP vulnerable plaque(group Ⅰ),UAP stable plaque(group Ⅱ)and SAP stable plaque(group Ⅲ).The plaque quantitative analysis software was used to quantitatively measure the volume and volume percentage of lipid,fiber and calcification in the plaque segments.One-way ANOVA was used to compare the volume and its percentage differences of lipid,fiber and calcification in the three groups,and LSD tests were used for pair-wise comparisons.The receiver operating characteristic curve (ROC curve) was used to analyze the diagnostic thresholds for the diagnosis of vulnerable plaques and stable plaques,and the corresponding sensitivity,specificity,positive predictive value (PPV) and negative prediction value (NPV) were calculated. Results: A total of 45 plaques were quantitatively analyzed and studied,with 10 plaques in group Ⅰ,9 plaques in group Ⅱ and 26 plaques in group Ⅲ.Vulnerable plaques and two groups of stable plaques in lipids (49.3%±4.1% vs 31.8%±6.3%,33.4%±6.9%) and calcification (2.9%±2.7% vs 13.0%±11.8%,17.2 Percentage of %±10.8%) were statistically significant ( P <0.05),the percentage of vulnerable lipid plaque was higher than that of stable plaque,and the percentage of calcified vulnerable plaque was lower than that of stable plaque;the volume of fibers between vulnerable plaques and UAP stable plaques was statistically different (47.5±14.4 vs 74.7±37.5)( P <0.05);there were no significant differences in the percentage of stable plaque between lipids (31.8%±6.3% vs 33.4%±6.9%) and calcification (13.0%±11.8% vs 17.2%± 10.8%)( P >0

关 键 词：易损性斑块 稳定性斑块 冠状动脉CT血管成像 320排CT 定量 

分 类 号：R814.42[医药卫生—影像医学与核医学] R541.4[医药卫生—放射医学]