512层极速CT冠状动脉造影对冠状动脉支架术后再狭窄的评估价值  

Evaluation of 512-slice ultra-fast CT in coronary in-stent restenosis

作　　者：荆彦平[1] 骆宾[1] 郭振安 徐雯静 荆怡玟 王茹茹 张晓东[2] 王彦桃 郭明凯 Jing Yanping;Luo Bin;Guo Zhen′an;Xu Wenjing;Jing Yiwen;Wang Ruru;Zhang Xiaodong;Wang Yantao;Guo Mingkai(Image Center,the Affiliate Huanghe Sanmenxia Hospital of Henan University of Science and Technology,Henan 472000,China;不详)

机构地区：[1]河南科技大学附属黄河三门峡医院影像中心,472000 [2]河南科技大学附属黄河三门峡医院心内科,472000

出　　处：《实用医学影像杂志》2022年第4期338-341,共4页Journal of Practical Medical Imaging

基　　金：中国电建集团医疗健康产业基金项目(2021003)。

摘　　要：目的 探讨512层极速CT冠状动脉造影(CTCA)对冠心病经皮冠状动脉介入治疗(PCI)支架术后再狭窄(ISR)的临床评估价值。方法 选择冠状动脉重度狭窄,并进行支架植入术后复查患者31例,支架数42个,进行512层极速CTCA检查,对冠状动脉ISR进行常规后处理与常规后处理联合斑块分析后处理分别进行评估,并与冠状动脉造影(CAG)结果做对比分析。结果 512层极速CTCA检查,对冠状动脉ISR进行常规后处理显示42枚支架中ISR阳性14枚(33.3%),ISR阴性28枚(66.7%),与金标椎CAG对照,其诊断的灵敏度、特异度、阳性预测值、阴性预测值和准确度分别为76.9%(10/13)、86.2%(25/29)、71.4%(10/14)、89.3%(25/28)、83.3%(35/42);对冠状动脉ISR进行常规后处理联合斑块分析后处理显示42枚支架中ISR阳性19枚(38.1%),ISR阴性23枚(61.9%),与金标椎CAG对照,其诊断的灵敏度、特异度、阳性预测值、阴性预测值和准确度分别为89.5%(17/19)、91.3%(21/23)、89.5%(17/19)、91.3%(21/23)、90.5%(38/42);采用Kappa分析评价2种后处理方法的一致性,Kappa=0.551,说明两者的一致性较好。结论 512层极速CTCA作为无创性检查手段,评价冠状动脉支架ISR的灵敏度和准确度较高,可作为冠状动脉支架植入术后患者随访的手段之一,采用常规后处理联合斑块分析后处理方式能更准确反映ISR的严重程度,值得推荐。Objective To explore the diagnosis value of 512-slice ultra-fast CTCA in coronary in-stent restenosis,in percutaneous coronary intervention for coronary heart disease.Methods Thirty-one patients with severe coronary artery stenosis and 42 stents were selected for review after stenting,and 512-slice ultra-fast CTCA examination was performed.Conventional post-treatment of coronary artery ISR and conventional post-treatment combined with plaque analysis post-treatment were respectively evaluated,and compared with the results of coronary angiography(CAG).Results 512-slice ultra-fast CTCA examination and conventional post-treatment of coronary artery ISR showed that 14 stents were ISR positive(33.3%)and 28 were ISR negative(66.7%).On the basis of CAG,the sensitivity,specificity,positive predictive value,negative predictive value and accuracy were 76.9%(10/13),86.2%(25/29),71.4%(10/14),89.3%(25/28),83.3%(35/42),respectively.Conventional post-treatment and plaque analysis of coronary ISR showed that 19 stents were ISR positive(38.1%)and 23 were ISR negative(61.9%),on the basis of CAG,the sensitivity,specificity,positive predictive value,negative predictive value and accuracy were 89.5%(17/19),91.3%(21/23),89.5%(17/19),91.3%(21/23),90.5%(38/42),respectively.Kappa analysis was used to evaluate the consistency of the two post-treatment methods,Kappa=0.551,indicating a good consistency between the two methods.Conclusion As a non-invasive examination method,512-slice ultra-fast CTCA has high sensitivity and accuracy in evaluating coronary stent ISR,and can be used for follow-up after coronary artery stenting.Meanwhile,conventional post-treatment combined with plaque analysis post-treatment can reflect the severity of ISR more accurately,which is worthy of recommendation.

关 键 词：体层摄影术 X线计算机 冠状血管造影术 冠状动脉再狭窄 

分 类 号：R541.4[医药卫生—心血管疾病] R816.2[医药卫生—内科学]