低剂量冠状动脉CT血管造影评估壁冠状动脉管腔的临床价值  

Clinical value of low-dose coronary CT angiography in the evaluation of mural coronary artery lumen

作　　者：王运兰[1] 张蕾 田志强[1] WANG Yunlan;ZHANG Lei;TIAN Zhiqiang(Medical Imaging Center,Panzhihua Central Hospital,Panzhihua,Sichuan 617067,China;Department of Radiology,the Affiliated Hospital of Panzhihua University,Panzhihua,Sichuan 617067,China)

机构地区：[1]攀枝花市中心医院医学影像中心,四川省攀枝花市617067 [2]攀枝花学院附属医院放射科,四川省攀枝花市617067

出　　处：《中国动脉硬化杂志》2020年第9期803-808,共6页Chinese Journal of Arteriosclerosis

摘　　要：目的探讨基于迭代重建算法(IRA)前瞻性心电门控低剂量冠状动脉CT血管造影(CCTA)技术评估壁冠状动脉管腔的临床价值。方法选取2015年1月至2018年1月期间于攀枝花市中心医院治疗并行CCTA检查确诊为左前降支心肌桥(MB)的160例患者为研究对象。以侵入性冠状动脉造影作为金标准。根据患者MB病变程度将其分为无收缩压迫组32例、轻度收缩压迫组56例以及重度收缩压迫组72例。测量并比较3组患者的壁冠状动脉管腔密度差异(MCA-COD)、冠状动脉腔内强化梯度(TAG)和标化TAG值以及MB长度,并采用受试者工作特征曲线(ROC曲线)评价标化TAG、MCA-COD以及MB长度对收缩压迫MB诊断的临床价值。结果随着收缩压迫程度增加,患者TAG、标化TAG值逐渐下降,MCA-COD以及MB长度逐渐增大;重度收缩压迫组与轻度收缩压迫组、无收缩压迫组相比,差异具有统计学意义(P<0.001)。在检查MB是否伴有收缩期压迫方面,MCA-COD的诊断敏感度和特异度相比标化TAG和MB长度更高,且三者联合检测在预测伴重度收缩压迫时的诊断价值更高。三者联合检测对轻度收缩压迫的诊断敏感度为83.12%,特异度为80.00%,ROC曲线下面积为0.816(95%CI 0.768~0.864);对重度收缩压迫的诊断敏感度为90.62%,特异度为87.50%,ROC曲线下面积为0.844(95%CI 0.799~0.890),相比各指标单独检测诊断价值更高。结论MCA-COD、标化TAG以及MB长度作为基于IRA的前瞻性心电门控低剂量CCTA检查指标,对于评估伴收缩压迫MB具有重要诊断价值。Aim To explore the clinical value of prospective ECG-gating low-dose coronary angiography(CCTA)based on iterative reconstruction algorithm(IRA)in the evaluation of mural coronary artery lumen.Methods From January 2015 to January 2018,160 patients with myocardial bridge(MB)of left anterior descending coronary artery diagnosed by CCTA and treated in Panzhihua Central Hospital were selected as research objects.Invasive coronary angiography was as the gold standard.According to the degree of MB lesion,the patients were divided into three groups:non-systolic compression group(32 cases),mild systolic compression group(56 cases)and severe systolic compression group(72 cases).The mural coronary artery-contrast opacification difference(MCA-COD),transluminal attenuation gradient(TAG),standardized TAG and MB length were measured and compared in the three groups.The clinical value of standardized TAG,MCA-COD and MB length in the diagnosis of systolic compression MB was evaluated by receiver operating characteristic curve(ROC).Results With the increase of the degree of systolic compression,the TAG and standardized TAG decreased gradually,and the MCA-COD and MB length increased gradually;The difference between the severe systolic compression group and the mild systolic compression group,the non-systolic compression group was statistically significant(P<0.001).MCA-COD had higher diagnostic sensitivity and specificity than standardized TAG and MB length in detecting whether MB was accompanied with systolic compression,and the combined detection of the three had higher diagnostic value in predicting severe systolic compression.In the mild systolic compression group,the sensitivity of the combined detection was 83.12%,the specificity was 80.00%,and the area under ROC curve was 0.816(95%CI 0.768~0.864);In the severe systolic compression group,the sensitivity of the combined detection was 90.62%,the specificity was 87.50%,and the area under ROC curve was 0.844(95%CI 0.799~0.890).The combined detection of the three was more valuable

关 键 词：冠状动脉CT血管造影 壁冠状动脉 心肌桥 收缩压迫 

分 类 号：R54[医药卫生—心血管疾病]