双源CT冠脉成像在冠脉狭窄诊断中的价值

Comparative study of dual-source CT coronary angiography and X-ray coronary angiography in the diagnosis of coronary artery stenosis

目的对双源CT(DSCT)冠状动脉成像与选择性X线冠状动脉造影(SCA)进行对比研究,评价DSCT对冠状动脉狭窄诊断的准确性。方法47例疑似冠心病患者(男35例,女12例,年龄63.3±10.4岁,心率76.2±14.8/min)在不控制心率的情况下行DSCT冠脉成像检查,在其后2周内行SCA检查以作为诊断冠状动脉狭窄的参考标准。将DSCT原始数据行多平面重建(MPR)、曲面重建(CPR)、最大密度投影(MIP)及容积再现技术(VRT)图像重建,结果分别由两名医师进行双盲评估。结果DSCT图像可评价节段达到94.98%(625/658),图像优良率95.52%(597/625)。DSCT诊断冠状动脉狭窄的敏感性、特异性、阳性预测值及阴性预测值分别为91.8%、98.3%、94.4%、97.5%,其中对左主干、左前降支及右冠状动脉的敏感性及特异性达到95%,对角支、左回旋支分支及右冠状动脉远端的诊断敏感性有所下降,分别为86.0%、71.4%、76.9%。结论在不控制心率的情况下,DSCT诊断冠脉狭窄安全可靠,可广泛用于冠心病患者的筛查、冠状动脉手术/支架术前评估及术后随访。

Objective To evaluate and compare the diagnostic accuracy of dual-source computed tomography （DSCT） and selective X-ray coronary angiography （SCA） in the diagnosis of coronary artery disease （CAD）. Methods Forty-seven patients with suspected CAD （35 males and 12 females with a mean age of 63. 32±10. 41 years and mean heart rate of 76.2±14. 8 beat/min） underwent DSCT coronary angiography without heart rate control, with SCA served as the reference standard, two weeks after the DSCT coronary angiography. Multi-planar reconstruction （MPR）, curved projection reconstruction （CPR）, maximum intensity projection （MIP） and volume reproduce technique （VRT） reconstruction of original DSCT data were respectively performed. The data sets were evaluated by 2 qualified blinded observers. Results In all the DSCT angiography images, 94. 98% （625/658） segments could be evaluated compared with SCA images, among which good image quality was obtained in 95. 52% （597/625） segments. Without heart rate control, the diagnostic sensitivity, specificity, positive and negative predictive value of DSCT in evaluating coronary artery stenosis were 91.8%, 97. 7%, 94. 3% and 97. 5%, respectively. The diagnostic sensitivity and specificity of DSCT was over 95% for the lesions of main left coronary artery, left anterior descending （LAD） and right coronary artery （RCA）, respectively, but the diagnostic sensitivity for the lesions of the diagonal branch, the branch of left circumflex coronary artery （LCX） and distal RCA declined to 86%, 71.4% and 76.9%, respectively. Conclusions DSCT coronary artery angiography may be used as a reliable method in the diagnosis of CAD without heart rate control, therefore it is valuable in screening patients with CAD, the preoperative evaluation and postoperative follow-up for coronary artery bypass surgery/stent implantation.