多排螺旋CT对冠状动脉斑块特征评价的精确性与血管内超声的比较

Diagnostic accuracy of multi-slice spiral CT to evaluate plaque characteristics compared with intravascular ultrasound

目的:对比血管内超声(IVUS),评价多排螺旋CT(MSCT)判断冠状动脉粥样硬化斑块特征的精确性。方法:连续性入选2007-08-2008-12期间在解放军总医院心内科诊断为冠心病并行MSCT、IVUS检查者,分别利用IVUS、MSCT方法测量同一病变的同一截面的血管截面积(V-CSA)、管腔截面积(L-CSA)、狭窄程度、斑块负荷(BP)、重构指数(RI)等指标;对比IVUS,计算MSCT判断狭窄程度及斑块性质的敏感性、特异性、阳性预测值(PPV)、阴性预测值(NPV)。结果:与IVUS对比,MSCT显示冠状动脉粥样硬化斑块的敏感性为98.0%,特异性为90.1%,PPV为93.0%,NPV为97.0%;显示狭窄程度>50.0%病变的敏感性为96.5%,特异性为97.1%,PPV为98.2%,NPV为94.3%;MSCT与IVUS测量冠状动脉同一病变同一截面下的V-CSA、L-CSA、BP及RI,各指标之间存在明显直线相关关系;MSCT判断脂质斑块的敏感性为88.9%,特异性为84.9%;纤维斑块的敏感性为73.3%,特异性为91.2%;钙化斑块的敏感性为95.7%,特异性为100%。结论:MSCT在诊断冠心病、判断冠状动脉粥样硬化斑块特征方面有较好的精确性,可做为无创性评估易损斑块的手段。

Objective：To detect the accuracy of multi-slice spiral CT（MSCT） in evaluating plaque characteristics compared with intravascular ultrasound（IVUS）. Method：Patients with known coronary heart diseases underwent MSCT and IVUS within one week after admission from August in 2007 to December in 2008 were included in this study.V-CSA,L-CSA,stenosis degree and plaque burden of the same section located in the same lesion were tested with two above different methods.Sensitivity,specificity,PPV and NPV of MSCT were calculated to evaluate the characteristics of plaque against IVUS. Result：Compared with IVUS,sensitivity,specificity,PPV,and NPV of MSCT for detecting plaque is 98%,90.1%,93%,and 97%,respectively.Sensitivity,specificity,PPV,and NPV of MSCT for detecting stenosis degree of coronary artery which is more than 50% is 96.5%,97.1%,98.2%,and 94.3%,respectively.V-CSA,L-CSA,BP and RI tested by MSCT and IVUS are rectilinear correlated significantly.Sensitivity,specificity of MSCT is 88.9% and 84.9% for recognizing lipid plaque,73.3% and 91.2% for fibrosis plaque,95.7% and 100% for calcified plaque. Conclusion：Compared with IVUS,MSCT is very accurate to evaluate the characterization of arteriosclerosis plaques.It can be a noninvasive tool to detect vulnerable plaque.