多层螺旋CT诊断冠状动脉狭窄的临床价值

The Diagnosis Value of MSCT on Coronary Artery Stenosis

目的评价多层螺旋CT(MSCT)诊断冠状动脉(冠脉)狭窄的价值。方法对35例疑似冠心病者行MSCT和冠脉造影(CAG)检查,以CAG结果为标准,按照4级分法分段评价MSCT冠脉图像的质量,对比分析其诊断各类冠脉狭窄的敏感性、特异性和准确性。根据图像显示粥样硬化斑块的CT值判定斑块性质,并总结斑块性质与狭窄程度的关系。结果本组291支冠脉中242支(83.2%)可评价,其中11例(31.4%)所有冠脉均可评价。MSCT检测冠脉狭窄≥50%的敏感性为88.6%,特异性为97.1%,阳性预测值为83.8%,阴性预测值为98.0%;粥样硬化斑块的性质与狭窄程度之间存在相应的关系,单纯钙化斑块所致狭窄程度较低,与非钙化斑块及混合斑块比较,差异均有统计学意义(P<0.01);非钙化斑块与混合斑块间比较差异无统计学意义(P>0.05)。结论 MSCT冠脉成像在显像质量较好的情况下具有较高的诊断价值,进一步判断粥样硬化斑块性质有助于提高冠脉成像诊断的准确性。

Objective To evaluate the diagnostic value of MSCT for coronary artery stenosis.Methods 35 suspicious CHD patients were detected with coronary MSCT and CAG.According to the results of CAG,the quantity of coronary artery MSCT was evaluated by four-grade classification.The sensitivity,specificity and accuracy of MSCT for the examination were analyzed and compared with the results of CAG.The plaque characteristics were differentiated according to the CT data in the images.And relationship between the plaque characteristics and stenosis degree were analyzed.Results In 291 coronary arteries,242 were evaluated（83.2%）.In 11 patients（31.4%）,all arteries were be evaluated.The sensitivity of stenosis detected by MSCT≥50% was 88.6%,specificity was 97.1%,positive predictive value was 83.8%,and negative predictive value was 98.0%.The atherosclerotic plaque characteristics were related to the degree of stenosis,and the degree of stenosis induced by simple calcified plaque was lower than those induced by non-calcified and mixed plaque,and the difference was significant（P0.01）,but there was no significant difference between non-calcified and mixed plaques（P0.05）.Conclusion MSCT has a high diagnosis value on coronary artery stenosis if image quality is satisfactory.The judgment of the atherosclerotic plaque characteristics may be helpful in raising the accuracy rate of MSCT coronary angiography.