基于病例的64层CT冠状动脉成像诊断评价

目的通过与传统冠状动脉造影（coronary angiography，CAG）对照，探讨基于病例的CT冠状动脉成像技术（CT coronary angiography，CTCA）在冠心病诊断中的应用价值。方法对拟诊冠心病患者205例作CTCA及CAG检查，以CAG为参照标准，分别采用美国心脏学会（American Heart Association，AHA）冠状动脉15段法和病例计数对CTCA诊断的冠心病进行统计学分析。结果基于病例数、不计冠状动脉狭窄程度误判与基于AHA冠状动脉15段法3种方法统计CTCA诊断冠心病的敏感度分别为87．9％、92．6％、93．4％，特异度为71．4％、78．6％、98．3％，准确度为83．4％、88．8％、97．1％，阳性预测值为89．1％、92．0％、94．8％，阴性预测值为69．0％、80．0％、97．8％。Kappa值分别为0．587，0．716，0．921。结论多层螺旋CT冠状动脉成像是诊断冠心病安全、可靠的方法，基于病例的诊断准确度（83．4％）明显低于基于冠状动脉段的准确度（97．1％），由于前者更能真实反映CAD的诊断价值，因此，CTCA诊断准确度尚需进一步提高。

Objective To access the application value of CT coronary angiography （CTCA） , which is controlled with coronary angiography（CAG） , in the diagnosis of coronary artery disease by using the number of cases and blood vessels segments as the unit, respectively. Methods Totally 205 cases of patients undergone CTCA and CAG within one month interval were analyzed retrospectively. Images were analyzed by two radiologists. Three statistical methods were employed to analyze coronary artery including case - based, case - based but without mis - determination of vascular stenosis, and segment - based （ American Heart Association, AHA 15 segments）. Results Based on three kinds of methods （based on the cases, based on the cases regardless of the degree of stenosis error, based on AHA 15 segments） , the sensitivity of CTCA diagnosis of coronary artery disease were 87.9% , 92. 6%, 93.4%, respectively, the specificity was 71.4%, 78.6%, 98.3 %, respectively, accuracy was 83.4%, 88.8%, 97. l%, respectively, positive predictive value of 89. 1% , 92. 0%, 94. 8%, and negative predictive value of 69. 0% , 80. 0% , 97.8%, respectively. The value of the Kappa was 0. 587 and 0. 716, 0. 921, respectively. Conclusions 64 - slice spiral CT coronary artery imaging is a non - invasive, safe and effective method in diagnosing coronary artery disease. However, the diagnostic accuracy of case - based of CTCA should be improved further.