钙化对基于冠状动脉CT血管成像的定量血流分数诊断准确度的影响  

Impact of calcification on the diagnostic accuracy of quantitative flow fraction based on coronary CT angiography

作　　者：马文珊 于鑫鑫 李莎 张帅 刘晓雪[1] 王锡明 Ma Wenshan;Yu Xinxin;Li Sha;Zhang Shuai;Liu Xiaoxue;Wang Ximing(School of Medical Imaging,Binzhou Medical University,Yantai 264003,China;Department of Radiology,Shandong Provincial Hospital Affiliated to Shandong First Medical University,Jinan 250021,China;Cheeloo College of Medicine,Shandong University,Jinan 250102,China)

机构地区：[1]滨州医学院医学影像学院,烟台264003 [2]山东第一医科大学附属省立医院医学影像科,济南250021 [3]山东大学齐鲁医学院,济南250102

出　　处：《中华放射学杂志》2023年第12期1331-1337,共7页Chinese Journal of Radiology

基　　金：国家自然科学基金 (82271993)。

摘　　要：目的探究钙化对冠状动脉CT血管成像(CCTA)衍生的定量血流分数(CT-QFR)诊断准确度的影响。方法回顾性纳入自2019年1月至2021年12月于山东第一医科大学附属省立医院同时行CCTA及有创冠状动脉造影(ICA)检查的疑似冠心病患者244例(471支冠状动脉)。所有分析均在血管水平上进行,基于CCTA、ICA图像对所有入组血管进行解剖学及血流动力学参数评估。依据病变钙化弧度是否大于180°分为严重钙化组(206支)、非严重钙化组(265支),比较两组冠状动脉狭窄程度、目标病变长度、钙化长度、钙化长度比、钙化重塑指数、定量血流分数(QFR)、CT-QFR以及受累血管分布等指标。通过Pearson相关性分析和Bland-Altman散点图评估不同分组CT-QFR与QFR结果的相关性与一致性。以QFR≤0.80作为冠状动脉缺血的参考标准,分别将CT-QFR≤0.80、管腔狭窄程度≥50%作为诊断冠状动脉缺血的标准,绘制ROC曲线评估在不同钙化分组中CT-QFR对冠状动脉缺血的诊断效能。结果严重钙化组的管腔狭窄程度、病变长度、钙化长度、钙化长度比及钙化重塑指数均高于非严重钙化组(P均<0.05)。Pearson相关性分析显示,CT-QFR与QFR在严重、非严重钙化组内均存在很强的相关性(r=0.85,95%CI 0.81~0.88,P<0.001;r=0.91,95%CI 0.89~0.93,P<0.001);Bland-Altman分析表明,CT-QFR与QFR在不同组间均有良好一致性,严重钙化组测定结果的平均差值为-0.01(95%一致性界限为-0.22~0.20),非严重钙化组的平均差值为0(95%一致性界限为-0.15~0.16)。严重钙化组CT-QFR、单纯CCTA对缺血性病变诊断的特异度、阳性预测值、阴性预测值及曲线下面积(AUC)均低于非严重钙化组,但CT-QFR在两组间的AUC差异无统计学意义(P>0.05),CCTA形态学评估两组间的AUC差异有统计学意义(P<0.001)。不同钙化分组CT-QFR对缺血性病变的诊断效能均显著优于单纯CCTA(P均<0.001)。结论严重钙化一定程度上影响了Objective To investigate the effect of calcification on the diagnostic accuracy of the quantitative flow fraction(CT-QFR)derived from coronary CT angiography(CCTA).Methods A total of 244 patients(471 coronary arteries)who underwent both CCTA and invasive coronary angiography(ICA)for suspected coronary artery disease between 2019 and 2021 were included in the study.All analyses were conducted at the vessel level using CCTA and ICA images,and the morphological and hemodynamic parameters of all enrolled vessels were assessed.The group was divided into severe calcification(206 cases)and non-severe calcification(265 cases)based on whether the arc of lesion calcification was greater than 180°.Subsequently,the two groups were evaluated to the degree of coronary stenosis,the length of the target lesion,the length of calcification,the ratio of the length of calcification,the remodeling index of calcification,the quantitative flow fraction(QFR),the CT-QFR,and the distribution of the involved vessels.Pearson correlation analysis and the Bland-Altman scatterplot were used to analyze the correlation and consistency between CT-QFR and QFR values from different subgroups.The benchmark for coronary ischemia was QFR≤0.80,and the criteria for diagnosing coronary ischemia were CT-QFR≤0.80 and luminal stenosis≥50%,respectively,and the effectiveness of CT-QFR for coronary ischemia was evaluated by plotting the ROC curves in various calcification subgroups.Results The degree of luminal stenosis,lesion length,calcification length ratio,and calcification remodeling index were substantially higher in the severely calcified group than in the non-severely calcified group(all P<0.05).The results of the Pearson correlation analysis demonstrated a significant association between CT-QFR and QFR in both the severe and non-severe calcification groups(r=0.85,95%CI 0.81-0.88,P<0.001;r=0.91,95%CI 0.89-0.93,P<0.001);in contrast,the Bland-Altman analysis indicated that the CT-QFR and QFR measurements in the severely calcified group exhibited a

关 键 词：冠心病 冠状动脉钙化 定量血流分数 心肌缺血 冠状动脉CT血管成像 

分 类 号：R816.2[医药卫生—放射医学]