64层CCTA对冠心病患者冠状动脉狭窄的诊断价值  

Diagnostic value of 64-slice CCTA on coronary artery stenosis in patients with coronary artery disease

作　　者：马方伟[1] 张蕾 陈首名[1] 何志兵[1] 何杰 MA Fangwei;ZHANG Lei;CHEN Shouming;HE Zhibing;HE Jie(Imaging Center,Panzhihua Hospital of Integrated Traditional Chinese and Western Medicine,Panzhihua 617000,Sichuan,China)

机构地区：[1]攀枝花市中西医结合医院影像中心,四川攀枝花617000

出　　处：《西部医学》2023年第7期1079-1082,1088,共5页Medical Journal of West China

基　　金：四川省医学会(恒瑞)科研基金专项科研课题(2021HR61)。

摘　　要：目的 探讨64层冠状动脉CT血管成像(CCTA)对冠心病(CAD)患者冠状动脉狭窄的诊断价值。方法 前瞻性纳入我院2021年4月—2022年4月就诊的118例疑为冠状动脉狭窄行CCTA及冠状动脉造影(CAG)的患者,以CAG检查结果为“金标准”,计算CCTA诊断CAD患者冠状动脉狭窄部位及狭窄程度的敏感度、特异性、阳性及阴性预测值,并比较CCTA诊断结果与CAG检查结果的一致性。结果 118例患者检查的冠脉节段共1215段,最终经CAG检查冠状动脉狭窄544段,其中轻度狭窄362段,中度狭窄133段,重度狭窄49段,闭塞0段;狭窄节段位于左主干有139段,左前降支有141段,左回旋支有92段,右冠状动脉有172段。CCTA共检出狭窄531段,漏诊13段,其中511段诊断正确,诊断准确率96.23%(511/531)。CCTA诊断冠状动脉狭窄部位及狭窄程度的敏感度、特异度、诊断符合率、kappa值均较高。斑块性质:CCTA共检出斑块489个,其中脂质斑块136个(27.81%),纤维斑块152个(31.08%),钙化斑块201个(41.10%)。结论 冠状动脉CT血管成像对冠心病患者冠状动脉狭窄部位、狭窄程度的诊断价值均较高,对冠状动脉狭窄患者斑块性质判断有一定的优势。Objective To explore the diagnostic value of 64-slice coronary CT angiography(CCTA)on coronary artery stenosis in patients with coronary artery disease(CAD).Methods 118 patients with suspected coronary artery stenosis treated in the hospital from April 2021 to April 2022 were prospectively enrolled for CCTA and coronary angiography(CAG).Taking results of coronary angiography as the“gold standard”,the sensitivity,specificity,positive and negative predictive values of CCTA in diagnosing the site and degree of coronary artery stenosis in patients with CAD were calculated,and the consistency of CCTA diagnostic results and CAG results was compared.Results A total of 1,215 segments of coronary arteries were examined in 118 patients,and 544 segments of coronary artery stenosis were finally examined by CAG,including 362 segments of mild stenosis,133 segments of moderate stenosis,49 segments of severe stenosis and 0 segment of occlusion.There were 139 segments in left main coronary artery,141 segments in left anterior descending artery,92 segments in left circumflex artery and 172 segments in right coronary artery.531 segments of stenosis were detected by CCTA and 13 segments were missed,of which 511 segments were correctly diagnosed with the diagnostic accuracy rate of 96.23%(511/531).The sensitivity,specificity,diagnostic coincidence rate and kappa value of CCTA were all higher in diagnosing the site and degree of coronary artery stenosis.Plaque property was shown that 489 plaques were detected by CCTA,including 136 lipid plaques(27.81%),152 fibrous plaques(31.08%)and 201 calcified plaques(41.10%).Conclusion Coronary CT angiography has high diagnostic value on coronary artery stenosis site and stenosis degree in patients with coronary artery disease,and has certain advantages in judging the plaque properties in patients with coronary artery stenosis.

关 键 词：冠状动脉CT血管成像 冠状动脉造影 冠心病 冠状动脉狭窄 

分 类 号：R816.2[医药卫生—放射医学]