复杂病变对基于冠状动脉CT血管成像的定量血流分数诊断准确度的影响  

Impact of Complex Lesions on the Diagnostic Accuracy of Quantitative Flow Fraction Based on Coronary CT Angiography

作　　者：刘晓雪[1] 于鑫鑫 康冰 高琳 马文珊 张帅 纪淙山 王锡明 LIU Xiao-xue;YU Xin-xin;KANG Bing;GAO Lin;MA Wen-shan;ZHANG Shuai;JI Cong-shan;WANG Xi-ming(School of Medical Imaging,Binzhou Medical University,Yantai 264003,Shandong Province,China;Department of radiology,Shandong Provincial Hospital Affiliated to Shandong First Medical University,Jinan 250021,Shandong Province,China)

机构地区：[1]滨州医学院医学影像学院,山东烟台264003 [2]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：《中国CT和MRI杂志》2025年第2期110-113,共4页Chinese Journal of CT and MRI

基　　金：国家自然科学基金(82271993)。

摘　　要：目的探讨CT-QFR在复杂病变中识别特异性缺血的诊断效能。方法本研究为一项回顾性分析,自2019年1月至2021年6月,连续招募了接受CCTA和侵入性冠状动脉造影(ICA)的患者。对三种不同类型的病变(局灶性病变、弥漫性病变和串联病变)进行了分析。以基于ICA的QFR作为参考标准评估CT-QFR在缺血性病变的诊断性能。结果共纳入171名患者420支血管。179(42.62%)支血管的QFR≤0.80。在血管水平上分析,CT-QFR与QFR之间诊断效能具有强相关性和良好一致性(r=0.868,P<0.001,mean difference±SD:0.01±0.09),总体诊断准确度、灵敏度和特异度分别为93.1%[95%CI,90.7–95.5]、88.88%[95%CI,83.3–93.0]和96.27%[95%CI,93.0-98.3]。在串联和非串联病变的血管之间(AUC=0.960 VS.0.961,P=0.964)以及弥漫性和局部病变之间(AUC=0.956 VS.0.943,P=0.655)发现了类似的诊断性能。结论在患者和血管水平分析中,CT-QFR在检测冠脉特异性缺血方面均显示出良好诊断性能,其诊断准确性未受串联或弥漫性病变斑块复杂性的影响。Objective We explored the role of CT-QFR in identifying ischemia-specific stenosis in complex lesion.Methods Patients with CCTA and ICA were consecutively enrolled in this post-hoc analysis from January 2019 to June 2021.Three different types of lesions(focal lesion,diffuse lesion and tandem lesion)were classified and analyzed.Diagnostic performance of CT-QFR in detecting hemodynamic significant stenosis was evaluated using invasive coronary angiography(ICA)-based QFR as a reference standard.Results A total of 171 patients with 420 vessels were included.179(42.62%)vessels had QFR≤0.80.Strong correlation and good agreement were observed between CT-QFR and QFR(r=0.868,P<0.001;mean difference±SD:0.01±0.09).The overall diagnostic accuracy,sensitivity and specificity were 93.1%[95%CI,90.7-95.5],88.88%[95%CI,83.3-93.0]and 96.27%[95%CI,93.0-98.3]on vessel level.Similar diagnostic performances were found between vessels with tandem and non-tandem lesions(AUC=0.960 versus 0.961,P=0.964)as well as diffuse and localized lesions(AUC=0.956 versus 0.943,P=0.655).Conclusion CT-QFR showed high diagnostic performance in detecting ischemia-specific coronary stenosis in both patient-level and vessel-level analysis,and its diagnostic accuracy was not affected by the plaque complexities of tandem or diffuse lesions.

关 键 词：冠心病 冠状动脉CT血管造影 定量血流分数 

分 类 号：R541.4[医药卫生—心血管疾病]