基于冠状动脉CT血管成像定量钙化负荷的可行性研究  

Feasibility study of calcium score quantitation based on coronary CT angiography

作　　者：邓瑗琳 张璋[1] 杨帆[1] 闫彦 李锋坦[1] 李东[1] DENG Yuanlin;ZHANG Zhang;YANG Fan;YAN Yan;LI Fengtan;LI Dong(Department of Radiology,Tianjin Medical University General Hospital,Tianjin 300052,China)

机构地区：[1]天津医科大学总医院,天津300052

出　　处：《国际医学放射学杂志》2021年第4期385-391,共7页International Journal of Medical Radiology

基　　金：国家自然科学基金(81301217);天津市自然科学基金(18JCYBJC25100);国家重点研发计划项目(2016YFC1300400);天津市应用基础与前沿技术研究计划(14JCZDJC57000);天津市卫生健康科技项目(MS20022)。

摘　　要：目的探讨冠状动脉CT血管成像(CCTA)一站式计算冠状动脉钙化积分(CCTA-CS)和体积积分(CCTA-VS)的可行性,并分析其与心电门控CT平扫测得标准积分(CACS、VS)的相关性。方法本研究回顾性连续纳入1075例受试者,男447例,女628例,平均年龄(56.79±9.49)岁。全部受试者均行包括门控CT平扫和CCTA的常规冠状动脉CT检查,测量CACS、VS、CCTA-CS和CCTA-VS。选择CACS与CCTA-CS均不为0的影像数据进行分析。采用组内相关系数(ICC)评估2名观察者间及观察者内测量CCTA-CS和CCTA-VS的一致性。采用线性相关分析与Bland-Altman检验分析CCTA与门控CT平扫所测评分的相关性与一致性。根据CACS对受试者进行心血管病危险度分层,并采用Kruskal-Wallis H检验比较多组间的CCTA-CS与CCTA-VS。采用二元Logistic回归分析影响钙化积分的危险因素。采用独立样本t检验比较CCTA和常规冠状动脉CT检查的有效辐射剂量(ED)。结果CACS和CCTA-CS不为0的受试者共437例。2名观察者间和观察者内测量的CCTA-CS和CCTA-VS的一致性均较好(均ICC>0.960)。CCTA-CS与CACS、CCTA-VS与VS均呈较好的正相关(r2=0.98、0.96,均P<0.05)。Bland-Altman检验结果显示CCTA与门控CT平扫所测评分间的一致性较高。不同危险分层病人的CCTA-CS和CCTA-VS差异均有统计学意义(均P<0.05)。Logistic回归分析显示高血压、糖尿病、高脂血症、吸烟史、脑血管病均为CACS、CCTA-CS的危险因素。CCTA检查的ED低于常规冠状动脉CT检查,Flash扫描可减少21.2%,Sequence扫描可减少18.6%。结论CCTA一站式测量可以精确定量钙化,测得的CCTA-CS、CCTA-VS与标准积分有较好的相关性,且能有效降低辐射剂量。Objective To explore the feasibility of coronary CT angiography(CCTA)for calcium score(CCTA-CS)and volume score(CCTA-VS)one-stop quantitation,and to test the correlations between the measurements obtained from CCTA and the ECG gated non-enhanced CT.Methods All of 1075 consecutive subjects were enrolled in this study retrospectively,447 males and 628 females,average age 56.79±9.49 years.All subjects underwent routine coronary artery CT examinations,including gated non-enhanced CT and CCTA.These parameters of coronary artery calcium score(CACS),volume score(VS),CCTA-CS and CCTA-VS were measured.The image data with neither CACS nor CCTA-CS of 0 were selected and analyzed.The intra-class correlation coefficient(ICC)was used to evaluate the inter-group and intra-group consistency of CCTA-CS and CCTA-VS measured by 2 observers.Linear correlation analysis and Bland-Altman test were used to compare the correlation and consistency between the measurements obtained from CCTA and gated non-enhanced CT.The subjects were stratified for cardiovascular risk according to CACS,and the Kruskal-Wallis H test was used to compare CCTA-CS and CCTA-VS among multiple groups.Binary logistic regression was used to analyze the risk factors affecting the calcium score,and the independent sample t test was used to compare the effective dose(ED)between CCTA and routine coronary artery CT examination.Results There were 437 patients with neither CACS nor CCTA-CS of 0.The measurement of CCTA-CS and CCTA-VS between two observers and within the observers had a high degree of consistency(all ICC>0.960).CCTA-CS and CACS,CCTA-VS and VS were all positively correlated(r2=0.98 and 0.96,both P<0.05).The Bland-Altman test showed high consistency between the scores measured by CCTA and gated non-enhanced CT.There were significant differences in CCTA-CS and CCTA-VS among the low,medium,and high risk stratification(all P<0.05).The logistic regression analysis showed the risk factors of CACS and CCTA-CS were hypertension,diabetes,hyperlipidemia,smoking histo

关 键 词：冠状动脉粥样硬化性心脏病 冠状动脉钙化积分 体积积分 冠状动脉CT血管成像 

分 类 号：R541.4[医药卫生—心血管疾病] R445.3[医药卫生—内科学]