64层螺旋CT与选择性冠状动脉造影的对照研究

A comparative study bewteen 64-slice spiral CT coronary angiography and selective coronary angiography

目的探讨64层螺旋CT冠状动脉成像(64SCTCA)在诊断冠状动脉粥样硬化性心脏病中的应用价值。方法50例临床诊断或可疑冠心病的患者(其中男29例,女21例,年龄40岁～81岁,平均65.8岁)2周内先后行64SCTCA和选择性冠状动脉造影(SCAG)检查,以SCAG为诊断标准,评价64SCTCA诊断冠心病的敏感性、特异性、阳性预测值和阴性预测值。结果在预计评估的450段血管中,共有435段(96.7%)的血管可用于影像学评价。64SCTCA诊断冠状动脉中度及中度以上狭窄(即管腔狭窄>50%)的敏感性、特异性、阳性预测值和阴性预测值分别为88.9%、97.5%、87.7%和97.8%;诊断冠状动脉轻度狭窄(即管腔狭窄≤50%)的敏感性、特异性、阳性预测值和阴性预测值分别为74.4%、96.2%、70.7%和96.8%。经配对χ2检验,P均>0.05,证明64SCTCA和SCAG两种检查方法在发现冠状动脉不同程度狭窄方面的差异无统计学意义。结论64SCTCA作为一种简便易行、安全可靠的无创性检查,在诊断冠状动脉狭窄时具有较高的敏感性和特异性,在冠心病的诊断和筛选和中具有重要价值。

Objective To evaluate the clinical value of 64-slice Spiral CT coronary angiography （64SCTCA） in the diagnosis of coronary heart disease. Methods Fifty patients （29 men , 21 women, mean age 65.8 years, range 40 - 81 years） with known or suspected coronary heart disease were examined with 64SCTCA and selective coronary angiography （SCAG） within two weeks. According to the results of SCAG as the reference standard, the sensitivity, specificity, positive and negative predictive values of 64SCTCA were calculated. Results Among the total number of coronary artery segments 96.7% （435/450） segments could be evaluated by 64SCTCA. The sensitivity , specificity , positive and negative predictive values of 64SCTCA to identify the significant coronary stenosis （ 〉 50 % lumen diameter narrowing） were 88.9% ,97.5% ,87.7% and 97.8%, respectively, while in the diagnosis of mild coronary stenosis （ ≤ 50 % lumen diameter narrowing）,they were 74.4 %, 96.2 %, 70.7 % and 96.8 % %, respectively. Statistical analysis using a 2-related χ^2 test showed no obvious difference in the discovery of coronary artery stenosis between 64SCTCA and SCAG. Conclusion As a simple , reliable and noninvasive method 64SCTCA has excellent sensitivity and specificity in detection of coronary stenosis and an important value in the screening and diagnosis of coronary heart disease.