双源CT冠脉CTA、CAG及IVUS对诊断冠脉粥样硬化价值的对比研究

The Value of Dual Source Computed Tomography Angiography in Diagnosis of coronary atherosclerosis:Compare with Coronary Angiography and Intravascular Ultrasound

目的探讨双源CT冠脉动脉CTA在冠脉粥样硬化中的诊疗价值。方法以自身对比的方法,分析2009年9月-2010年3月共24例临床疑似冠状动脉病变患者的双源CT冠状CTA、CAG及IVUS的检查资料;男19例,女5例,平均年龄57.25岁;以IVUS检查结果为标准,评价:①DSCT对冠脉狭窄的诊断价值;②DSCT对斑块性质的诊断价值。结果 24例患者有24条冠脉,91个测量位置参与了统计分析:①冠脉病变狭窄程度上,三种方法它们两两之间结果无统计学意义,[U1]并且具有较高的相关性(rDSCT与IVUS:0.789、rDSCT与CAG:0.828、rCAG与IVUS:0.757);②DSCT与IVUS在辨别冠脉斑块成分上无明显差异(Z=-1.063、P=0.288),它们所显示的斑块成分呈密切正相关(r=0.719);③DSCT与IVUS在测量冠脉斑块偏心指数上无明显差异(Z=-0.816、P=0.414),它们所显示的斑块偏心指数呈中度正相关(r=0.583)。结论 DSCTA能准确评估冠脉狭窄程度,且能辨别管壁斑块性质,是一种无创、操作简单的诊断冠状动脉病变检查方法,可为高危人群筛查首选方法。

Objective To investigate the value of dual source computed tomographyAngiography（DSCTA） in diagnosis of coronary atherosclerosis.Methods 24 cases（19 males and 5 females,mean age 57.25 years） were collected from Sep 2009 to Mar 2010 underwent DSCTA,CAG and Intravascular Ultrasound simultaneously（IVUS） in one month.The IVUS results were served as ＂gold standard＂ to evaluate the diagnostic accuracy of DSCT in the degree of stenosis and plaque characteristics of coronary atherosclerotic.Results 91 segments of coronary artery in 24 patients were evaluated by DSCTA,CAG and IVUS：1.There were no statistical differences（P0.05） and high positive correlations（rDSCT and IVUS：0.789,rDSCT and CAG：0.828,rCAG and IVUS：0.757） in the diagnosis of coronary artery stenosis in 3 methods.2.There were no statistical differences（Z=-1.063,P=0.288） and high positive correlations（r=0.719） in distinguishing the reconstituent of plaques between DSCTA and IVUS.3.There were no statistical differences（Z=-0.816,P=0.414） and midrange positive correlations（r=0.583） in showing the eccentricity index of plaques between DSCT and IVUS.Conclusion DSCTA can not only provides high accuracy in detecting stenosis of coronary artery,but also show the composition and character of the plaques.It is a useful and non-invasive method in detecting coronary arteries disease.