64层螺旋CT对冠状动脉病变的评价

Diagnostic accuracy of 64-slice computed tomography for detecting angiographically significant coronary artery stenosis

目的探讨64层螺旋计算机X射线断层造影(64-slice spiral computed tomography,64-sCT)评价稳定型心绞痛病人冠状动脉病变的准确性。方法拟诊稳定型心绞痛34例,男28例,女6例;年龄(66±12)岁,行64-sCT冠状动脉扫描,并于检查15d内行冠状动脉造影。对所有病人的冠状动脉544节段分析,将结果与冠状动脉造影结果对比。结果64-sCT显示冠状动脉狭窄的敏感度为52%,特异度为96%,阳性预测价值74%,阴性预测价值90%。对每条冠状动脉进行分析,诊断敏感度为76%,特异度为99%,阳性预测价值98%,阴性预测价值83%。对病人进行评价,诊断敏感度为97%,特异度为33%,阳性预测价值94%,阴性预测价值50%。结论64-sCT评价冠状动脉病变的准确性高,有临床应用价值。

Objectives To evaluate the diagnostic accuracy of 64-slice computed tomography in the detection of significant coronary artery disease in stable angina pectoris patients, using coronary angiograghy as the gold standard. Methods CT angiography was performed in 34 patients （28 male, 6 female; mean age 66±12 years） with suspected coronary artery disease and compared with invasive coronary angiography within 15 days. Significant stenosis was defined as a diameter reduction 〉50%. Results Of 578 segments, 544 （94.1%） were assessable. Compared with coronary angiograghy, on the segment-based analysis, the sensitivity of CT to diagnose significant stenosis was 51.5%, specificity 96.1%, positive predictive value （PPV） 74% and negative predictive value （NPV） 90%. On the patient-based analysis, the sensitivity, specificity, PPV and NPV of CT to detect CAD were 76%, 99%, 98% and 83%, respectively. Conclusions 64-slice computed tomography has a high accuracy for the detection of significant coronary artery stenosis and therefore can be considered as a valuable noninvasive technique.