双源CT冠脉成像与冠脉造影对冠心病诊断价值的分析

The Clinical Value of Dual Source Computed Tomography Angiography and Coronary Angiography in Coronary Heart Disease Diagnosis

目的评价64排双源螺旋CT(DSCT)冠状动脉成像在冠心病诊断中的应用价值.方法以有创的冠脉造影(CAG)的结果为金标准,使用64排DSCT对50例疑似或确诊的冠心病患者的200支冠脉共578个节段进行分析,评价DSCT对冠脉明显狭窄(狭窄≥50%)诊断的情况.结果DSCT检出冠心病的准确程度达到97.7%.分别以节段和各支冠脉进行分析,DSCT诊断冠脉狭窄的灵敏度、特异度、阳性预测值、阴性预测值和诊断的符合率分别为79.7%、96.9%、87.5%、94.6%、93.3%和85.6%、90.9%、88.5%、88.5%、88.5%.以不同部位的冠脉病变对CAG和DSCT的诊断结果进行比对分析,DSCT对于前降支(LAD)和回旋支(LCX)病变诊断的灵敏度和特异度以及诊断的符合率均较高.对DSCT和CAG检出冠脉狭窄节段或发现病变冠脉的能力进行经χ2检验,χ2值分别为3.497和1.737,P>0.05,DSCT和CAG在发现冠脉的狭窄上差异无统计学意义.结论64排DSCT冠脉成像是一种无创的成像方法,检出冠心病的准确程度高,作为冠心病的一种无创筛查手段具有很高的临床应用价值.

Objective To evaluate the clinical value of 64-slice dual source computed tomography angiography （DSCT） in diagnosis of coronary heart disease. Methods DSCT angiography was performed on 50 patients with suspected or proven coronary heart diseases and coronary angiography （CAG） was performed in these patients within 4 weeks. We analyzed their 578 segments of 200 coronary artery bunches. The CAG results were served as ＂gold standard＂ to evaluate the diagnostic accuracy of DSCT in coronary artery significant stenosis （diameter reduction 〉150% ）. Results The sensitivity, specificity, positive predictive value, negative predictive value and agreement rate of DSCT were 79.7%, 96.9%, 87.5%, 94.6% and 93.3% in per-segment analysis. In per-artery analysis, the sensitivity, specificity, positive predictive value, negative predictive value and agreement rate of DSCT were 85.6%, 90.9%, 88.5%, 88.5% and 88.5%. The rate of coronary heart disease identified by DSCT was 97.7%. There was no statistical difference in the diagnosis of coronary artery stenosis between DSCT and CAG （P 〉 0.05）. Conclusion 64-slice DSCT is a noninvasive method for diagnosing the coronary artery stenosis which provided a high diagnostic accuracy.