基于CT的冠状动脉血流储备分数对冠状动脉含钙化病变的诊断评价  

Diagnostic evaluation of CT-based non-invasive fractional flow reserve in coronary artery lesions with calcification

作　　者：杨琳[1] 徐磊[1] 何继强[2] 王志强 范占明[1] 周玉杰[2] Yang Lin;Xu Lei;He Jiqiang;Wang Zhiqiang;Fan Zhanming;Zhou Yujie(Department of Radiology,Beijing Anzhen Hospital,Capital Medical University,Beijing 100029,China;Department of Cardiology,Beijing Anzhen Hospital,Capital Medical University,Beijing 100029,China)

机构地区：[1]首都医科大学附属北京安贞医院医学影像科,100029 [2]首都医科大学附属北京安贞医院心内科,100029

出　　处：《中华放射学杂志》2019年第8期668-674,共7页Chinese Journal of Radiology

基　　金：国家重点研发专项(2016YFC1300301);国家自然科学基金(81771791);首都医科大学附属北京安贞医院院长科技发展基金-培育基金(2016P06).

摘　　要：目的与有创血流储备分数(FFR)结果对比,分析钙化因素与CT-FFR测量结果的相关性,评价CT-FFR在含钙化冠状动脉病变中的诊断效能。方法回顾性纳入自2014年7月至2016年12月在北京安贞医院就诊的患者65例(74支冠状动脉病变血管),均已完成冠状动脉CT成像、冠状动脉造影及有创FFR测量,且病变中均含有钙化。对冠状动脉CT数据进行斑块成分定量分析、冠状动脉病变狭窄程度及CT-FFR值测量。对患者基础资料依据FFR值进行分组比较,计量资料采用独立样本t检验,计数资料采用χ^2检验。依据FFR及CT-FFR值分组,采用独立样本t检验或秩和检验对斑块定量测量值进行组间比较。采用组内相关系数(ICC)对CT-FFR测量软件的可重复性进行评价,并计算Youden指数确定CT-FFR诊断缺血的阈值。采用Pearson或Spearman相关分析评估CT斑块定量指标与CT-FFR及有创性FFR结果的相关性。采用多因素logistic回归分析FFR和CT-FFR判断缺血的影响因素。与有创FFR结果对照,评价CT-FFR诊断冠状动脉缺血性病变的敏感度、特异度、阴性预测值、阳性预测值、ROC曲线下面积,并用Bland-Altman方法评价诊断一致性。结果与有创FFR相比,CT-FFR与斑块中的钙化体积及钙化占比间具有相关性(r值分别为-0.519和-0.547,P=0.001)。多因素logistic回归分析,斑块长度是有创FFR判断病变缺血的预测因子(OR=1.13,95%CI:1.05~1.23,P=0.002),而与CT-FFR判断病变缺血相关的预测因子除斑块长度(OR=1.10,95%CI:1.02~1.18,P=0.010)外,还包含有斑块钙化成分占比(OR=1.09,95%CI:1.03~1.15,P=0.003)。与有创FFR结果对照,CT-FFR诊断缺血的敏感度79.1%,特异度80.6%,阳性预测值85.0%,ROC曲线下面积(AUC)值为0.78,与根据CT冠状动脉成像管腔狭窄程度判断缺血病变的诊断效能相比,两者间差异有统计学意义(χ^2=10.05,P=0.002;χ^2=34.71,P=0.001;χ^2=7.65,P=0.006;Z=2.10,P=0.029)。Bland-Altman分析显示CT-FFR与有创FFR�Objective To analyze the correlation between calcification factors and fractional flow reserve derived from CT (CT-FFR).And to evaluate the diagnostic efficacy of CT-FFR in coronary artery lesions with calcification compared with that of invasive FFR.Methods Sixty-five patients (74 coronary artery vessels) who were admitted to Beijing Anzhen Hospital from July 2014 to December 2016 were included in this study retrospectively.All patients had completed CCTA (coronary CT angiography),coronary angiography and invasive FFR measurements,and had coronary lesions contain calcifications.The evaluation of CCTA data included quantitative analyses of plaque components,coronary artery stenosis,and CT-FFR measurements.The patients′ basic data were grouped and compared according to the FFR values.The measurement data was tested by independent-samples t tests,and the categorical data were analyzed by χ^2 tests.Quantitative measurements of plaques were compared between groups using independent-sample t tests or rank sum tests based on FFR and CT-FFR values.The reproducibility of CT-FFR measurement software was evaluated by inter-class correlation coefficient (ICC) and the Youden index was calculated to determine the threshold for CT-FFR diagnosis of ischemia.Pearson or Spearman correlation analyses were used to assess the correlations between CT plaque quantitative indicators,CT-FFR and invasive FFR.Multivariate logistic regression analysis was used to analyze the predictors of ischemia by FFR and CT-FFR.In contrast to invasive FFR results,the sensitivity,specificity,negative predictive value,positive predictive value (PPV) of CT-FFR in the diagnosis of coronary ischemic lesions were evaluated,and the diagnostic consistency was evaluated by the Bland-Altman method.Results Compared with invasive FFR,CT-FFR had a more significant correlation with calcification volume and ratio of calcification in plaques (r=-0.519 and -0.547,respectively,both P=0.001).Multivariate logistic regression analysis showed that plaque length was a pre

关 键 词：体层摄影术 X线计算机 冠状血管 钙化 生理性 血流储备分数 心肌 

分 类 号：R541.4[医药卫生—心血管疾病]