冠状动脉CTA腔内密度校正差诊断冠脉支架后再狭窄的价值  

Diagnostic value of the difference of corrected contrast opacification for coronary in-stent restenosis with CT angiography

作　　者：高亚婷 王丽娟 王晋 侯凯 孙桂芳 GAO Ya-ting;WANG Li-juan;WANG Jin(Department of Radiology,Yan’an Hospital,Key Laboratory of Cardiovascular Diseases of Yunnan Province,Clinical Medicine Center for Cardiovascular Diseases of Yunnan Province,Kunming 650051,China)

机构地区：[1]昆明市延安医院放射科云南省心血管疾病重点实验室云南省心脏疾病临床医学中心,昆明650051

出　　处：《放射学实践》2023年第3期263-266,共4页Radiologic Practice

基　　金：昆明市卫生科技人才培养项目暨“十百千”工程培养计划(2020-SW(后备)-21);昆明市卫生健康委员会卫生科研课题(2020-09-01-116);昆明市延安医院第六批学术和技术带头人后备人选计划项目(RC6-04);昆明市延安医院院内课题(yyky019-020)。

摘　　要：目的:以有创冠状动脉造影(ICA)为金标准,评估冠状动脉CTA(CCTA)腔内密度校正差(DCCO)诊断冠状动脉支架后再狭窄(ISR)的价值。方法:回顾性分析于1个月内相继行CCTA及ICA检查并既往已行冠状动脉支架术患者的影像资料,测量CCTA支架近段和远段及对应同层面主动脉CT值,记为C1、C2、A1、A2,定义DCCO=C1/A1-C2/A2。以ICA为金标准,以冠状动脉支架后狭窄程度是否≥50%分为无再狭窄组和再狭窄组,评估CCTA、DCCO及二者联合分别诊断ISR的准确性和受试者操作特征(ROC)曲线下面积(AUC)。结果:共89例99支血管纳入分析,无冠状动脉ISR和发生冠状动脉ISR组的DCCO分别为0.10±0.06、0.19±0.08,无冠状动脉ISR组和发生冠状动脉ISR组DCCO联合CCTA分别为0.33±0.23、0.72±0.26,差异均有统计学意义(P<0.05)。DCCO单独诊断及DCCO联合CCTA诊断ISR的效能均高于CCTA,DCCO联合CCTA的AUC为0.86,均分别高于DCCO和CCTA的AUC(0.82和0.72,P均<0.05)。结论:冠状动脉CTA腔内密度校正差可一定程度提高CCTA诊断冠状动脉ISR的准确性。Objective:To evaluate the diagnostic value of the difference of corrected contrast opacification(DCCO)for coronary in-stent restenosis(ISR)with coronary computed tomographic angiography(CCTA),using invasive coronary angiography(ICA)as a reference standard.Methods:Patients who had undergone coronary artery stent implantation and had CCTA and ICA images within one month successively were retrospectively analyzed.Intraluminal attenuation in the proximal and distal of the coronary stent and in descending aorta on the same axial section were measured,recording as C1、C2、A1、A2.We defined DCCO=C1/A1-C2/A2.All vessels were divided into no-restenosis and in-stent stenosis groups according to the ICA results(whether diameter stenosis≥50%or not).The diagnostical efficiency of CCTA,DCCO and the combination of them in predicting the stenosis were evaluated by the accuracy and area under the receiver operating characteristic curve(AUC).Results:99 vessels of 89 patients were assessed,and the DCCO alone and DCCO/CCTA combination were associated with the classification of coronary in-stent stenosis,the differences between them were statistically significant(0.10±0.06 vs 0.19±0.08 and 0.33±0.23 vs 0.72±0.26;both P<0.05).The performance of DCCO and DCCO/CCTA combination exceled the CCTA,the AUC of DCCO/CCTA combination was 0.86,which was significantly higher than DCCO and CCTA(0.82 and 0.72,respectively;both P<0.05).Conclusion:The DCCO may increase the diagnostic accuracy of ISR with CCTA.

关 键 词：冠状动脉造影 体层摄影术 X线计算机 腔内密度校正差 支架后再狭窄 

分 类 号：R814.42[医药卫生—影像医学与核医学] R543.3[医药卫生—放射医学]