多排螺旋CT对冠状动脉狭窄性病变诊断能力的研究

Study on Diagnostic Ability of Multi-slice Spiral Computed Tomography in coronary artery stenoses

目的：探讨多排螺旋CT（MSCT）冠状动脉成像质量及诊断价值。方法：115例临床疑似、确诊冠心病患者同时行MSCT、CAG检查。结果：冠脉左主干、前降支近中段、回旋支近段及右冠近段、远段成像质量优于其远段和侧枝（P=0.000）。MSCT对不同程度病变诊断情况有统计学差异（P=0.000）。MSCT、CAG冠脉狭窄程度Gensini量化评分正相关（rs=0.937,P=0.000）,评判结果高度一致（K值0.813,P=0.000）。MSCT检测不同程度、不同节段冠脉病变的特异度和阴性预测值较高,分别为88．8％～99．0％、93．9％～99．7％、83．6％～100％、89．5％～100%；但敏感度、阳性预测值存在差异，分别为57．1％～96．5％、26．7％～92．6％、66．7％～100%、59．2％～100％。结论：MSCT对冠脉常见部位成像质量高，与CAG具有很高的诊断一致性，可作为临床冠心病筛查手段。

Objective：To investigate the coronary artery imaging quality of multi-slice spiral computed tomography（MSCT） and its clinical diagnostic value.Methods：One hundred fifteen patients with diagnosed or suspected coronary heart disease were examined with 64MSCT and coronary arteriography（CAG）.Results：The imaging quality of the left main artery（LM）,the proximal and middle portions of left anterior descending artery（LAD）,the proximal portion of left circumflex artery（LCX） and the proximal and distal segments of right coronary artery（RCA） was superior to its distal and lateral artery branch（P=0.000）.There were significant differences for MSCT in diagnoses of varying degrees coronary artery stenoses（P=0.000）.There was positive correlation in coronary stenosis Gensini score between MSCT and CAG（rs=0.937,P=0.000）.Diagnostic results of coronary artery stenoses of MSCT and CAG＇s were consistent（Kappa value 0.813,P=0.000）.To evaluate the accuracy of MSCT detection of coronary lesions based on the extent of coronary artery lesions and anatomical position of blood vessel segment,the results showed that specificity and negative predictive value were high： 88.8%～99.0%、93.9%～99.7%,83.6%～100%、89.5%～100%,respectively;while the differences of both the sensitivity value and the positive predictive value were significant,57.1%～96.5%、26.7%～92.6%,66.7%～100%、59.2%～100%,separately.Conclusion：MSCT can be used as a clinical non-invasive screening common examination mean for coronary heart disease because of high quality MSCT imaging of the coronary artery lesion common site and better diagnostic consistency with CAG.