多参数能谱扫描在诊断冠状动脉支架内再狭窄中的应用价值  

Value of Multiparametric Energy Spectrum Scanning in the Diagnosis of In⁃stent Restenosis of Coronary Arteries

作　　者：祁冬[1] 李娟[2] 李科民[3] 施彪[1] 姚木子 胡淑敏[1] QI Dong;LI Juan;LI Kemin;SHI Biao;YAO Muzi;HU Shumin(Department of Medical Imaging,Bengbu First People′s Hospital,Bengbu 233000,Anhui,China;Department of Neurology,Bengbu First People′s Hospital,Bengbu 233000,Anhui,China;Department of Cardiology,Bengbu First People′s Hospital,Bengbu 233000,Anhui,China)

机构地区：[1]蚌埠市第一人民医院医学影像科,安徽蚌埠233000 [2]蚌埠市第一人民医院神经内科,安徽蚌埠233000 [3]蚌埠市第一人民医院心内科,安徽蚌埠233000

出　　处：《中国分子心脏病学杂志》2024年第6期6498-6504,共7页Molecular Cardiology of China

基　　金：蚌埠市科技创新指导类项目(20230101)

摘　　要：目的探讨应用多参数能谱扫描诊断冠状动脉支架内再狭窄(in-stent restenosis,ISR)的价值。方法回顾性收集2020年1月至2023年11月80例行冠状动脉支架植入患者作为研究对象,随机分为能谱扫描组和普通扫描组,每组40例,所有患者均行冠状动脉CT血管成像(coronary computed tomography angiography,CCTA)和经皮冠状动脉造影(coronary angiography,CAG)检查。对能谱扫描组患者数据采用能谱软件分析,观察支架内狭窄处与非狭窄处的能谱曲线特征并计算曲线斜率;采用物质分离技术(碘/水图)观察支架内的显示效果,并测量支架内狭窄处与非狭窄处的碘浓度和有效原子序数并比较其差异。以CAG为金标准,计算2种扫描方式诊断冠状动脉支架内再狭窄的灵敏度、特异度、阳性预测值、阴性预测值和准确度,并应用Kappa检验评价其结果一致性。采用受试者操作特征(receiver operator characteristic,ROC)曲线分析碘浓度、能谱曲线斜率及有效原子序数诊断ISR的预测价值。结果能谱扫描组图像质量评分高于普通扫描组[(2.52±0.14)分比(0.65±0.23)分],差异有统计学意义(P<0.05);冠状动脉支架内腔狭窄处平均碘浓度、能谱曲线平均斜率、有效原子序数均低于非狭窄处(P均<0.05)。能谱扫描诊断ISR的灵敏度、特异度、阳性预测值、阴性预测值及准确度分别为93.10%、90.91%、96.43%、83.33%和92.50%,均高于普通扫描(P均<0.05);且与CAG一致性较好(Kappa值为0.817,P<0.001)。ROC曲线分析结果显示,能谱扫描诊断ISR的曲线下面积(area under the curve,AUC)值为0.920,高于普通扫描(P<0.001);碘浓度、能谱曲线斜率和有效原子序数诊断ISR的AUC值分别为0.817、0.768和0.788,其诊断临界值分别为34.23 mg/mL、4.09和8.55,诊断灵敏度分别为87.89%、80.76%和83.53%,诊断特异度分别为84.21%、79.64%和81.67%。结论与普通扫描相比,能谱扫描可使用多个参数定量分析冠状动脉支架�Objective To investigate the value of applying multiparametric energy spectrum scanning in the diagnosis of in⁃stent restenosis(ISR)of coronary arteries.Methods A total of 80 patients who all underwent coronary stenting from January 2020 to November 2023 were retrospectively collected as study subjects.The patients were randomly divided into the energy spectrum scanning group and the normal scanning group,with 40 cases in each group,and all the patients underwent coronary artery computed tomography angiography(CCTA)and percutaneous coronary angiography(CAG)in each group.The data of patients in the energy spectrum scan group were analyzed using energy spectrum software.Observe the characteristics of the energy spectrum curves in the stenoses and non⁃stenoses areas and calculate the slope of the curves;observe the display effect in the stent using the substance separation technique(iodine/water imaging)and measure the iodine concentration and effective atomic number in the stenoses and non⁃stenoses areas and compare the differences.To calculate the sensitivity,specificity,positive predictive value,negative predictive value and accuracy of the 2 scanning modalities for the diagnosis of coronary in⁃stent restenosis(ISR),using CAG as the gold standard,and to evaluate the consistency of the results by applying the Kappa test.Predictive value of iodine concentration,energy spectrum slope and effective atomic number diagnostic ISR using receiver operator characteristic(ROC)curves.Results The image quality score of the energy spectrum scanning group was higher than that of the normal scanning group(2.52±0.14 vs 0.65±0.23),with a statistically significant difference(P<0.05);the mean iodine concentration and effective atomic number in the coronary stent luminal stenoses areas were lower than that in the non⁃stenoses areas(both P<0.05);the mean slope of the energy spectrum curve in the coronary stent luminal stenoses areas was lower than that in the non⁃stenoses areas(P<0.05).The sensitivity,specificity,positiv

关 键 词：多参数能谱扫描 普通扫描 冠状动脉CT血管成像 冠状动脉造影 支架内再狭窄 

分 类 号：R541.4[医药卫生—心血管疾病]