64排CT冠状动脉造影定量分析在冠状动脉临界病变中的价值

Quantitative analysis by 64-slice computed tomography in diagnosis of intermediate coronary artery stenosis

目的评价64排CT冠状动脉造影对临界病变定量分析的可行性。方法入选2009年5月—2010年8月于上海交通大学附属胸科医院行64排CT冠状动脉造影检查提示为临界病变的91例患者,共205处病变。在2周内进行经皮冠状动脉造影及定量冠状动脉造影(QCA)分析。采用Bland-Altman分析和Pearson相关分析对比64排CT冠状动脉造影定量分析与QCA的结果。结果 64排CT冠状动脉造影检查示,病变参考直径为(3.1±0.4)mm,病变长度为(14.2±11.3)mm;狭窄程度为(57.8±0.7)%,与QCA测定的(58.2±13.9)%的差异无统计学意义(P=0.64)。205个经64排CT冠状动脉造影定量分析示冠状动脉狭窄程度为40%～70%的病变中,QCA检查示27个病变(13.2%)的狭窄程度低于40%,43个病变(21.0%)高于70%,135个病变(65.9%)属于冠状动脉狭窄程度为40%～70%的临界病变。64排CT冠状动脉造影定量分析与QCA结果呈中度相关(r=0.599,P<0.001),但一致性较差(平均偏差为0.4%,95%一致性可信区间为-22.1%～22.9%)。结论 64排CT冠状动脉造影对临界病变的诊断价值有限,其定量分析与QCA的一致性欠佳,目前临床实用价值有限。

Objective To evaluate the feasibility of quantitative analysis by 64-slice computed tomography （CT） in intermediate coronary artery lesions. Methods Totally 91 patients with 205 lesions were diagnosed as intermediate coronary artery stenosis by 64-slice CT from May 2009 to August 2010. Conventional percutaneous coronary angiography was performed within 2 weeks after CT scan. The results of 64-slice CT quantitative analysis and quantitive coronary angiography （QCA） were compared by Bland-Altman analysis and Pearson correlations. Results The average reference values of lesions were （3. 1 ± 0.4） mm in diameter and （ 14.2 ± 11.3） mm in length by CT scan. Diameter stenosis was （57.8 ＋ 0.7） % by CT quantification and （58.2 ± 13.91 ） % by QCA; there was no significant difference between the two methods （ P = 0.64）. Of these lesions, only 135 lesions （65.9%） were confirmed by QCA as intermediate lesion with 40% -70% stenosis, while 27 （13.2 % ） less than 40 % and 43 （21.0%） more than 70 %. There was a moderate correlation （r = 0. 599, P〈 0.001 ） and a poor agreement （average bias was 0.4 % and 95 % confidence interval was - 22.1% to - 22.9 % ） between CT quantification and QCA. Conclusion Quantitative analysis results with 64-stice CT are not consistent with QCA. Therefore, it is not enough to diagnose intermediate coronary artery stentosis in clinical practice. （Shanghai Med J, 2012, 35; 200-202）