CCTA与CT-FFR诊断冠状动脉缺血病变的应用价值  

Application value of CCTA and CT-FFR in diagnosis of coronary ischemic disease

作　　者：周康锴 应璇 潘婷 ZHOU Kangkai;YING Xuan;PAN Ting(Graduate School of Zhejiang Chinese Medical University,Hangzhou 310032,Zhejiang,China;Department of Imaging,Jinhua People’s Hospital,Jinhua 321000,Zhejiang,China;Three Department of Cardiology,Jinhua People’s Hospital,Jinhua 321000,Zhejiang,China)

机构地区：[1]浙江中医药大学研究生院,浙江杭州310032 [2]金华市人民医院影像科,浙江金华321000 [3]金华市人民医院心内三科,浙江金华321000

出　　处：《中国现代医生》2024年第22期50-53,91,共5页China Modern Doctor

摘　　要：目的探讨冠状动脉CT血管成像(coronary CT angiography,CCTA)与CT血管造影血流储备分数(CT angiography derived fractional flow reserve,CT-FFR)诊断冠状动脉缺血病变(coronary ischemic disease,CID)的应用价值。方法选取2021年5月至2023年6月于金华市人民医院诊治的108例冠心病患者为研究对象,以冠状动脉造影为金标准,根据心肌血流储备分数将其分为CID组(n=66)和非CID组(n=42)。比较两组患者的CCTA参数[最小管腔面积(minimum lumen area,MLA)、最小管腔直径(minimum lumen diameter,MLD)、狭窄面积百分比(percentage of area stenosis,%AS)、狭窄直径百分比(percentage of diameter stenosis,%DS)]和CT-FFR;分析CID组患者的临床特征与MLA、MLD、%AS、%DS、CT-FFR的关系。绘制受试者操作特征曲线(receiver operating characteristic curve,ROC曲线)分析CCTA、CT-FFR诊断CID的效能。结果CID组患者的MLA、MLD、CT-FFR均显著低于非CID组,%AS、%DS均显著高于非CID组(P<0.05)。重度钙化、狭窄者的MLA、MLD、CT-FFR均显著低于轻中度钙化、狭窄者,%AS、%DS均显著高于轻中度钙化、狭窄者(P<0.05)。MLA、MLD、CT-FFR与钙化程度、狭窄程度均呈负相关,%AS、%DS与钙化程度、狭窄程度均呈正相关(P<0.05)。CT-FFR的诊断确诊率高于CCTA(86.11%vs.70.37%,χ^(2)=7.859,P<0.05)。ROC曲线分析显示,CCTA、CT-FFR诊断CID的曲线下面积(area under the curve,AUC)分别为0.706、0.860;CT-FFR的AUC高于CCTA(Z=2.347,P<0.05)。结论CCTA与CT-FFR对CID诊断均有一定价值,但CT-FFR效能更高,提供心肌缺血信息更全面。Objective To investigate the application value of coronary CT angiography(CCTA)and CT angiography derived fractional flow reserve(CT-FFR)in diagnosis of coronary ischemic disease(CID).Methods A total of 108 patients with coronary heart disease treated in Jinhua People’s Hospital from May 2021 to June 2023 were selected as study objects.Using coronary angiography as the gold standard,the patients were divided into CID group(n=66)and non-CID group(n=42)according to myocardial fractional flow reserve.CCTA parameters[minimum lumen area(MLA),minimum lumen diameter(MLD),percentage of area stenosis(%AS),percentage of diameter stenosis(%DS)]and CT-FFR were compared between two groups.The relationship between clinical features and MLA,MLD,%AS,%DS and CT-FFR in CID group was analyzed.Receiver operating characteristic(ROC)curve was drawn to analyze the effectiveness of CCTA and CT-FFR in diagnosing CID.Results MLA,MLD and CT-FFR in CID group were significantly lower than those in non-CID group,and%AS and%DS were significantly higher than those in non-CID group(P<0.05).MLA,MLD,and CT-FFR in patients with severe calcification or stenosis were lower than those in patients with mild-to-moderate calcification or stenosis,while%AS and%DS were higher than those in patients with mild-to-moderate calcification or stenosis(P<0.05).MLA,MLD,and CT-FFR were negatively correlated with the degree of calcification and stenosis,and%AS and%DS were positively correlated with the degree of calcification and stenosis(P<0.05).The diagnostic accuracy of CT-FFR was higher than that of CCTA(86.11%vs.70.37%,χ^(2)=7.859,P<0.05).ROC curve analysis showed that area under the curve(AUC)of CCTA and CT-FFR for diagnosing CID were 0.706 and 0.860,respectively.AUC of CT-FFR was higher than that of CCTA(Z=2.347,P<0.05).Conclusion Both CCTA and CT-FFR have certain value in diagnosis of CID,but CT-FFR is more efficient and provides more comprehensive information of myocardial ischemia.

关 键 词：CT血管成像 CT血管造影血流储备分数 冠状动脉缺血病变 

分 类 号：R445.3[医药卫生—影像医学与核医学] R541.4[医药卫生—诊断学]