自动软件在经导管主动脉瓣置换术前评估中的价值:与手动测量的对比研究  

Value of automated software in the preoperative evaluation of transcatheter aortic valve replacement: a comparative study with manual measurement

作　　者：黄书苑 于鑫鑫 杨宝珠 王锡明 HUANG Shuyuan;YU Xinxin;YANG Baozhu;WANG Ximing(Department of Medical Imaging,Shandong Provincial Hospital Affiliated to Shandong First Medical University,Jinan 250021,Shandong,China)

机构地区：[1]山东第一医科大学附属省立医院医学影像科,山东济南250021

出　　处：《山东大学学报（医学版）》2024年第11期22-31,共10页Journal of Shandong University:Health Sciences

基　　金：国家自然科学基金(82271993)。

摘　　要：目的 评价自动分析软件ValvePlus在经导管主动脉瓣置换术(transcatheter aortic valve replacement, TAVR)术前评估的价值,探讨其与手动测量的相关性、一致性,分析瓣膜钙化程度对测量结果的影响,并比较测量耗时及所推荐瓣膜型号的准确性。方法 回顾性搜集138例行主动脉CTA检查的主动脉瓣狭窄患者的临床及影像资料,分别采用手动及自动软件测量主动脉瓣环面积、周长、最大直径及最小直径;左、右冠状动脉开口高度;升主动脉、左室流出道、窦管交界处的最大直径、最小直径;三个主动脉窦到对侧结合部的距离等参数,记录测量耗时,使用皮尔逊相关系数(r)及组内相关系数(intraclass correlation coefficient, ICC)比较两种方法的相关性及一致性,并绘制Bland-Altman图进一步分析差异,根据瓣膜钙化程度分组,比较不同亚组的相关性及一致性,使用配对样本t检验比较二者测量时间,采用Kappa检验评价两种方法推荐瓣膜型号及与最终实际选择瓣膜型号的一致性。结果 138例患者中男93例,平均64岁,所有患者主动脉瓣均为三叶瓣,80.4%的患者合并轻度及以上主动脉瓣返流。手动测量与自动测量具有较好的相关性及一致性,r值为0.844~0.990,ICC为0.841~0.988,其中瓣环面积的r值及ICC最高,分别为0.990、0.988。96例患者瓣膜中重度钙化,不同瓣膜钙化亚组,两种方法均具有较高的相关性及一致性,r及ICC均>0.8。自动测量显著缩短了测量时间[3 min(29±24)s vs. 8 min(14±36)s,P<0.001]。基于自动测量的瓣环面积、周长、平均直径推荐瓣膜型号与实际应用瓣膜型号的Kappa分别为0.886、0.765、0.761。结论 ValvePlus可以提供可靠的TAVR术前主动脉根部解剖参数信息,在不同钙化亚组与手动测量均具有较高的相关性及一致性,并且显著减少测量所需时间,基于自动测量所推荐瓣膜型号较准确,有助于辅助TAVR团队进行精准评估,指导�Objective To evaluate the value of automatic analysis software(ValvePlus)before transcatheter aortic valve replacement(TAVR),discuss the correlation and consistency between ValvePlus and manual measurement,assess the influence of different degrees of valve calcification on measurement outcomes,and compare the time between the two and the accuracy of recommended valve sizes.Methods Clinical and imaging data from 138 patients with aortic stenosis who underwent aorta computed tomography angiography(CTA)were retrospectively collected.The area,circumference,maximum diameter,and minimum diameter of the aortic annulus,distance to the left and right coronary arteries,maximum diameter and minimum diameter of the ascending aorta,left ventricular outflow tract,sinotubular junction,and distance from the coronary sinus to the contralateral commissure were measured by manual method and automatic software,and the measurement time was recorded.Pearsons correlation coefficient(r)and intraclass correlation coefficient(ICC)were used to compare correlation and consistency,and Bland-Altman was plotted to further analyze the differences.The patients were categorized based on the extent of valve calcification,and the correlation and consistency among the different subgroups were compared,and a paired t-test was used to compare the time of measurements.The Kappa test was used to evaluate the consistency between the valve size recommended by the two methods and the actual valve size.Results Among the 138 patients,93 were male,with a mean age of 64 years.All patients presented tricuspid aortic valves and 80.4%exhibited mild or higher aortic regurgitation.Automatic measurement was in good correlation and consistency with manual measurement,with the r values of 0.844-0.990 and the ICC values of 0.841-0.988,and the r and ICC values of the area of aortic annulus were the highest,respectively 0.990 and 0.988.A total of 96 patients exhibited moderate to severe cardiac valve calcification,and there was a high correlation and consistency between

关 键 词：经导管主动脉瓣置换术 主动脉瓣狭窄 主动脉瓣环 CT血管造影 

分 类 号：R445.3[医药卫生—影像医学与核医学]