64层CT与血管内超声对冠状动脉粥样斑块的定性和定量评估的对照研究

Qualitative and quantitative evaluation of coronary plaques with 64-slice computed tomography in comparison with intravascular ultrasound

目的对照血管内超声(intravascular ultrasound,IVUS)评价64层 CT 对冠状动脉粥样斑块的定性检测和定量分析。方法 2005年7月至10月连续纳入12例拟行 PCI 的稳定性心绞痛患者进行研究。所有患者术前接受64层 CT 的冠状动脉成像,术中行三支冠状动脉(左前降支、回旋支和右冠状动脉)的 IVUS 检查。结果共对31支血管(左前降支12支,回旋支10支,右冠状动脉9支),88个节段进行了64层 CT 和 IVUS 的对比检查,其中64层 CT 可评价节段为68个。在 IVUS检测到的51个有斑块节段中,64层 CT 检测出47个(敏感性92%),在17个 IVUS 判断为无斑块的节段中,64层 CT 判断16个为无斑块(特异性94%)。64层 CT 测量的斑块面积和 IVUS 测量的斑块面积相关(r=0.53,P<0.01),但是高估了斑块面积[(9.09±3.89)mm^2比(6.80±2.81)mm^2,P<0.01]。64层 CT 在43个 IVUS 测定的低回声成分中检出30个为低密度成分,平均 CT 值67.39 HU。结论冠状动脉无严重钙化时,64层 CT 可准确检测冠状动脉近中段粥样斑块。64层 CT 测量的斑块面积虽然和 IVUS 测量结果相关,但准确测量受限。

Objective To explore the diagnostic feasibility of noninvasive assessment of coronary atheroselerotie plaques with MSCT in comparison with IVUS. Methods Contrast-enhanced MSCT angiography （Sensation 64, Siemens Medical Solutions ） was performed before percutaneous coronary intervention （PCI）, and three-vessel IVUS （ Boston Scientific, Natiek, MA） was performed during procedure in 12 patients with stable angina peetoris. Complete investigation was digitally stored, and assessed offline with EehoPlaque （ Indee Systems, Mountain View, CA）. The comparison of MSCT with IVUS was performed based on segment at plaque site （American Heart Association 15-segment model）. Results A total of 88 segments in 31 vessels （left anterior descending： 12, left circumflex： 10, and right coronary artery： 9 ） were investigated by both IVUS and MSCT. Among 68 assessable segments （54 proximal-middle segments and 14 distal segments ） by MSCT （20 segments were excluded for poor image quality： 16 for severe calcification, 2 for motion artifact, 2 for poor opacifieation）, MSCT correctly detected 47 of the 51 segments with plaques （sensitivity： 92% ）, and correctly evaluated 16 of 17 segments without plaques （specificity： 94% ）. Concerning plaque quantification, MSCT correlated well with IVUS in grading whether the vessel obstruction was less or more than 50% （simple kappa： 0. 63, 95% CI： from 0. 47 to 0.78）. Plaque area by MSCT also correlated with that by IVUS （r = 0.53 ,P 〈0.01 ）, but overestimated plaque area [ （9.09 ± 3.89） mm^2 vs. （6. 80 ± 2. 81 ） mm2, P 〈 0. 01 ]. In addition, 30 of 43 hypoechoic compositions were detected as low-density compositions by MSCT with average CT number as 67.39 HU. Conclusions In segments without severe calcification, contrast-enhanced 64-slice CT angiography could detect plaques in coronary artery with high accuracy. Plaque area quantification by MSCT correlated with that of IVUS though with limited accuracy.