多层螺旋CT(MSCT)诊断冠状动脉狭窄程度的准确性及漏诊、误诊的原因分析  

The Accuracy of Multi-slice Spiral CT(MSCT)in the Diagnosis of Coronar y Artery Stenosis and the Causes of Missed Diagnosis and Misdiagnosis

作　　者：赵爽[1] 曹美楠 徐广玲[1] ZHAO Shuang;CAO Mei-nan;XU Guang-ling(Department of Radiology,962 Hospital of PLA Joint Logistic Support Force,Harbin 150030,Heilongjiang Province,China)

机构地区：[1]中国人民解放军联勤保障部队第九六二医院放射诊断科,黑龙江哈尔滨150030

出　　处：《中国CT和MRI杂志》2023年第5期58-60,共3页Chinese Journal of CT and MRI

摘　　要：目的 探讨多层螺旋CT(MSCT)诊断冠状动脉狭窄程度的准确性,并分析漏诊和误诊的影响因素。方法 选择2019年5月至2022年6月于我院收治的冠心病患者96例,纳入患者均行MSCT检查,以冠状动脉造影(CAG)检查结果为金标准,分析MSCT的诊断效能,评价MSCT的诊断效能并分析漏诊和误诊的影响因素。结果 MSCTA与CAG诊断不同程度冠状动脉狭窄程度的Kappa值均>0.75,两种诊断方法具有较高的一致性。MSCTA诊断冠状动脉轻度狭窄误诊1段,漏诊2段,诊断的敏感度、特异度及准确性为96.55%、99.07%、98.18%;诊断冠状动脉中度狭窄误诊4段,漏诊1段,诊断的敏感度、特异度及准确性为95.24%、97.22%、96.97%;诊断冠状动脉重度狭窄1段,漏诊2段,诊断的敏感度、特异度及准确性为93.75%、99.25%、98.18%。误诊原因包括客观原因(血管充盈不佳、斑块钙化、测量误差、伪影)及观因素(中心线偏离)。漏诊原因包括包括客观原因(血管充盈不佳、斑块钙化)及观因素(未取到最窄层面)。结论 256层MSCTA在冠状动脉狭窄诊断中发挥重要作用,其灵敏度、特异性及准确性高,安全可靠,血管充盈不佳和斑块钙化是导致MSCTA漏诊及误诊的主要原因。Objective To explore the accuracy of multi-slice spiral CT(MSCT)in diagnosing of coronary artery stenosis,and to analyze the influencing factors of missed diagnosis and misdiagnosis.Methods 96 patients with coronary heart disease admitted to our hospital from May 2019 to June 2022 were selected,all the included patients underwent MSCT.Taking the results of CAG as gold standard,the diagnostic efficiency of MSCT was evaluated,and the influencing factors of missed diagnosis and misdiagnosis were analyzed.Results The kappa value of MSCTA and CAG in diagnosing different degrees of coronary artery stenosis was higher than 0.75,and the two diagnostic methods have high consistency.The diagnostic sensitivity,specificity and accuracy of MSCTA in the diagnosis of mild coronary artery stenosiswere were 96.55%,99.07%and 98.18%,respectively.4 segments were misdiagnosed and 1 segment was missed in the diagnosis of moderate coronary artery stenosis,the sensitivity,specificity and accuracy of diagnosis were 95.24%,97.22%and 96.97%.One segment of severe coronary artery stenosis was diagnosed,and two segments were missed,the sensitivity was 93.75%,the specificity was 99.25%,and the accuracy was 98.18%.The causes of misdiagnosis include objective causes(poor vascular filling,plaque calcification,measurement error,artifact)and visual factors(centerline deviation).The reasons for missed diagnosis include objective reasons(poor vascular filling,plaque calcification)and visual factors(the narrowest layer is not taken).Conclusions 256 slice MSCTA plays an important role in the diagnosis of coronary artery stenosis,with high sensitivity,specificity and accuracy,which is safe and reliable.Poor vascular filling and plaque calcification are the main reasons for missed diagnosis and misdiagnosis of MSCTA.

关 键 词：多层螺旋CT 冠状动脉狭窄程度 冠状动脉造影 漏诊 误诊 

分 类 号：R445.3[医药卫生—影像医学与核医学]