对比增强磁共振冠状动脉成像对冠状动脉狭窄的诊断效能分析

The Analysis of Diagnostic Efficiency of Coronary Artery Stenosis Using Contrast-Enhanced Coronary Magnetic Resonance Angiography

目的探讨对比增强磁共振冠状动脉成像(CE CMRA)诊断冠状动脉明显狭窄(≥50%)的临床应用价值。资料与方法 21例疑似冠状动脉粥样硬化性心脏病患者与23名自愿者分别行CE CMRA及不使用对比剂磁共振冠状动脉成像(CMRA),经Soap-Bubble软件重组后处理获得左、右冠状动脉图像,比较其血管锐利度差异;其中行CE CMRA患者与其选择性冠状动脉造影(CAG)检查对照,按冠状动脉解剖节段进行配对比较,评价CE CM-RA对冠状动脉明显狭窄的诊断效能。结果 CE CMRA与CMRA分别获得20例、22例有效图像数据;CE CMRA与CMRA的冠状动脉血管锐利度分别为:RCA(63±12)%、(55±10)%;LCA(LM+LAD)(57±12)%、(47±16)%;LCX(47±13)%、(37±16)%;两者间差异均有统计学意义(P<0.05)。以CAG为参照标准,CE CMRA诊断冠状动脉明显狭窄的敏感性、特异性、准确性分别为79.3%、91.6%、89.4%,阳性预测值和阴性预测值分别为67.6%和95.2%。结论 CE CMRA可定性评价冠状动脉明显狭窄,尤其适用于冠状动脉明显狭窄的排除性诊断,有重要的临床应用价值。

Objective To discuss the value of contrast-enhanced coronary magnetic resonance angiography（CE CMRA）in the diagnosis of remarkable stenosis of coronary artery.Materials and Methods 21 patients with suspected coronary artery disease and 23 volunteers were performed with CE CMRA and coronary MR angiography（CMRA）respectively.The major coronary arteries were acquired with Soap Bubble software and sharpness of coronary arteries were compared.According corresponding anatomical segment,remarkable stenosis of coronary arteries were compared in the CE CMRA patients and coronary angiography（CAG）,and diagnostic efficiency of coronary artery stenosis was evaluated using CE CMRA.Results 20 and 22 objects were successfully obtained with CE CMRA and CMRA respectively.In groups of CE CMRA and CMRA,sharpness of coronary arteries were RCA（63±12）%,（55±10）%;LCA（LM＋LAD）（57±12）%,（47±16）%;LCX（47±13）%,（37±16）% respectively.Statistical differences were significant between them（P 0.05）.With CAG as the reference,sensitivity,specificity and accuracy of CE CMRA in the diagnosis of coronary remarkable stenosis were 79.3%,91.6%,89.4% respectively.Positive predictive value and negative predictive value were 67.6%,95.2% respectively.Conclusion CE CMRA can evaluate qualitatively for remarkable coronary stenosis and is useful for the exclusion diagnosis of remarkable coronary stenosis especially,which has important clinical values.