校正的管腔内密度变化对冠状动脉钙化斑块诊断价值的研究  

The Value of Corrected Coronary Opacification Change in the Diagnosis of Coronary Artery Calcified Plaque

作　　者：杨国华 方正[2] 冯杰 范小涛 YANG Guohua;FANG Zheng;FENG Jie;FAN Xiaotao(Department of Radiology,Fengdu County People’s Hospital;Department of Radiology,The Second Affiliated Hospital,Chongqing Medical University)

机构地区：[1]重庆市丰都县人民医院放射科 [2]重庆医科大学附属第二医院放射科

出　　处：《中国医学计算机成像杂志》2021年第5期414-419,共6页Chinese Computed Medical Imaging

基　　金：重庆市科卫联合医学科研项目(2019MSXM085)。

摘　　要：目的:以冠状动脉造影(ICA)为参照,评价校正的冠状动脉管腔内密度变化(CCO)和冠状动脉CT血管成像(CCTA)在诊断钙化斑块处管腔狭窄程度中的价值。方法:回顾性分析冠状动脉有钙化斑块的患者73例106支血管。以ICA为标准将冠状动脉狭窄程度分为轻度组(<50%)、中度组(50%~69%)和重度组(≥70%)。分析CCO在3组间的差异。计算CCO、CCTA和CCO+CCTA诊断管腔狭窄的灵敏度、特异度、阳性预测值和阴性预测值,并对比受试者操作特征(ROC)曲线下面积。结果:总共106支有钙化斑块的冠状动脉,轻度组55支、中度组37支、重度组14支。3组的CCO(单位:HU)分别为0.054±0.090、0.079±0.116和0.247±0.150,重度组与轻度组、中度组间差异均有统计学意义(P<0.01),轻度组与中度组间差异无统计学意义(P=0.288)。CCO、CCTA和CCO+CCTA诊断狭窄≥50%的ROC曲线下面积分别为0.671、0.574和0.675,CCTA与CCO+CCTA间差异有统计学意义(P=0.0490),余组间差异无统计学意义;三者诊断狭窄≥70%的ROC曲线下面积分别为0.904、0.550和0.906,其中CCTA与CCO间、CCTA与CCO+CCTA间差异有统计学意义(P<0.0001)。结论:冠状动脉钙化斑块处CCO随管腔狭窄程度增加而增高;联合CCO有助于提高CCTA对钙化斑块处狭窄程度的诊断准确度。Purpose:To evaluate the value of corrected coronary opacification(CCO)and coronary CT angiography(CCTA)in the diagnosis of stenosis of calcified plaque by comparing with invasive coronary angiography(ICA).Methods:A retrospective analysis was performed in 73 patients(106 coronary arteries)with calcified plaque.The coronary artery stenoses were divided into mild group(<50%),moderate group(50%-69%)and severe group(≥70%)according to the results of ICA.The differences of CCO among the three groups were analyzed.The sensitivity,specificity,positive predictive value and negative predictive value of CCO,CCTA and CCO+CCTA in diagnosing luminal stenosis were calculated,and the area under the receiver operator characteristic(ROC)curve was compared.Results:There were 106 coronary arteries with calcified plaque,55 in the mild group,37 in the moderate group and 14 in the severe group.CCO(unit:HU)of the three groups was 0.054±0.090,0.079±0.116 and0.247±0.150,respectively.The difference of CCO between severe group and mild group,severe group and moderate group was with statistical significance(all P<0.01),while the difference between mild group and moderate group was with no statistical significance(P=0.288).The area under ROC curve(AUC)for diagnosis of stenosis≥50%of CCO,CCTA and CCO+CCTA was 0.671,0.574 and 0.675,respectively.The difference of AUC between CCTA and CCO+CCTA was with statistical significance(P=0.0490),while the difference between other groups was with no statistical significance.The AUC for diagnosis of stenosis≥70%of CCO,CCTA and CCO+CCTA was 0.904,0.550 and 0.906,respectively.The difference of AUC between CCTA and CCO,CCTA and CCO+CCTA was with statistical significance(all P<0.0001).Conclusion:CCO in calcified coronary plaque increased with the degree of stenosis.CCO combined with CCTA can improve the diagnostic accuracy of calcified plaque stenosis.

关 键 词：校正的冠状动脉管腔内密度变化 冠状动脉 CT血管成像 钙化斑块 

分 类 号：R445.3[医药卫生—影像医学与核医学]