CT管腔内对比度衰减梯度及改良校正的管腔内对比度衰减梯度对冠状动脉功能性狭窄的诊断初探  

The preliminary assessment of transluminal attenuation gradient and modified transluminal attenuation gradient-corrected coronary opacification for coronary arterial functional stenosis

作　　者：阚晓婧[1] 葛英辉[1] 刘霄静 张继良[1] 谢瑞刚[1] 潘玉坤 KAN Xiaojing;GE Yinghui;LIU Xiaojing;ZHANG Jiliang;XIE Ruigang;Pan Yukun(Department of Radiology,Henan Provincial People’s Hospital,Fuwai Central China Cardiovascular Hospital,Zhengzhou 450003,P.R.China)

机构地区：[1]河南省人民医院阜外华中心血管病医院放射科

出　　处：《医学影像学杂志》2019年第12期2034-2037,共4页Journal of Medical Imaging

基　　金：河南省医学科技攻关项目(编号:201702160);河南省科技厅立项项目(编号:172102310520)

摘　　要：目的探讨并比较CT管腔内对比度衰减梯度(TAG)和改良校正的管腔内对比度衰减梯度(MTAG-CCO)对冠状动脉功能性狭窄的诊断价值。方法收集2016年2月~2017年8月来我院就诊并有意愿行CCTA及FFR检查的冠心病患者。将所有冠状动脉分为无功能性狭窄组(FFR>0.80)和功能性狭窄组(FFR≤0.80);记录每支冠状动脉的TAG、MTAG-CCO及FFR值,比较两组间TAG、MTAG-CCO,并计算TAG、TAG-CCO、CCTA及TAG+CCTA及MTAG-CCO+CCTA对功能性狭窄的灵敏度、特异度,阳性预测值和阴性预测值。结果纳入35例患者(37支冠状动脉)。无功能性狭窄组和功能性狭窄组(-15.39±2.250 vs-19.87±2.054)HU/10mm的TAG之间不存在显著性差异(P=0.1561),MTAG-CCO(-0.02521±0.001867 vs-0.03260±0.002369)/10mm之间存在显著性差异(P=0.0179)。单独CCTA的敏感度、特异度、阳性预测值和阴性预测值分别为50.0%,17.6%,41.7%和23.1%;TAG分别为55.0%,11.8%,42.3%和18.2%;MTAG-CCO分别为15.0%,41.2%,23.1%和29.2%;TAG+CCTA分别为90.0%,5.9%,52.9%和33.3%;MTAG-CCO+CCTA分别为50.0%,52.9%,55.6%和47.4%。结论MTAG-CCO较TAG有进一步区别冠状动脉功能性狭窄的可能性;MTAG-CCO+CCTA的敏感度、特异度均较高。Objective The aim of this study was compared the transluminal attenuation gradient(TAG)and modified transluminal attenuation gradient-corrected coronary opacification(MTAG-CCO)in assessing coronary artery functional stenosis.Methods This prospective study recuited coronary artery stenosis patients who intented to do CCTA and FFR examination.All the vessels were divided into 2 groups:non-functional stenosis group(FFR>0.80)and functional stenosis group(FFR≤0.80).The TAG,MTAG-CCO and FFR values were recorded.All the TAG,MTAG-CCO were compared respectively.The sensitivity,specificity,positive predictive value and negative predictive value of TAG,MTAG-CCO,CCTA and MTAG-CCO+CCTA,and TAG+CCTA were evaluated.Results 35 patients(37 coronary arteries)were recuited.The TAG of non-functional stenosis group and functional stenosis group was(-15.39±2.250,-19.87±2.054)HU/10mm(P=0.1561),MTAG-CCO of the 2 group was(-0.02521±0.001867,-0.03260±0.002369)/mm(P=0.0179).The sensitivity,specificity,positive predictive value and negative predictive value of CCTA were 50.0%,17.6%,41.7%and 23.1%;TAG was 55.0%,11.8%,42.3%and 18.2%;MTAG-CCO were 15.0%,41.2%,23.1%and 29.2%;TAG+CCTA were 90.0%,5.9%,52.9%and 33.3%;MTAG-CCO+CCTA were 50.0%,52.9%,55.6%and 47.4%.Conclusion MTAG-CCO had the potential to further differentiate coronary artery functional stenosis compared with TAG;MTAG-CCO+CCTA had higher sensitivity and specificity.

关 键 词：冠心病 体层摄影术 X线计算机 冠状动脉成像 密度梯度 

分 类 号：R541.4[医药卫生—心血管疾病] R814.42[医药卫生—内科学]