冠脉内超声、电子束CT及冠脉造影检测冠脉粥样硬化病变的对比研究

A comparative study of EBCT,ICUS and CAG for detection of coronary atherosclerosis

目的 比较和评价冠脉内超声 (ICUS)、电子束CT(EBCT)及冠脉造影 (CAG)检测冠脉粥样硬化病变的价值。方法 10例患者同时行ICUS、EBCT和CAG检查。对所成像的 10支靶血管共 3 5个血管段 ,逐个血管段比较分析其检测冠脉粥样病变的结果。结果 ①CAG正常的 19个血管段中 ,9段( 4 7.4% )ICUS显示粥样斑块 ,斑块负荷 ( 3 3 .0± 14 .0 ) % ( 14 .5 %～ 5 2 .2 % ) ,6段 ( 3 1.6% )EBCT存在钙化 ;②与ICUS相比 ,CAG和EBCT诊断冠脉所有病变总的敏感性均为 64 .0 % ,特异性分别为 10 0 %和 90 .0 % ,准确性分别为 74.3 %和 71.4% (P =0 .763 ) ;③EBCT诊断钙化斑块和脂质纤维斑块的敏感性、特异性、阳性预测值、阴性预测值、准确性分别为 92 .3 % ,77.3 % ,70 .6% ,94.4% ,82 .9%和 3 3 .3 % ,43 .5 % ,2 3 .5 % ,5 5 .6% ,40 .0 %。结论 ①对CAG正常血管 ,ICUS和EBCT均有助于发现冠脉早期病变或被CAG低估的病变 ;②以ICUS作为判断冠脉粥样病变的“金标准” ,EBCT和CAG对冠脉粥样斑块的诊断效率相近 ;③EBCT对钙化病变的检出率较高 ,对少部分脂质纤维斑块仍可检出有钙盐沉积。

Objective To analyze and compare the preliminary results of electron beam computed tomography(EBCT) with those of intracoronary ultrasound (ICUS) and coronary angiography (CAG) for in vivo detection of coronary atherosclerotic plaques.Methods Ten patients (seven males and three females) with an average age of (65±7) years were included in the study.On a site by site basis,35 coronary segments in ten target vessels were analyzed with EBCT,CAG and ICUS.Results Atherosclerotic plaque was found by ICUS in nine( 47.4 %) of 19 segments with normal angiogram,and the plaque burden measured by ICUS was ( 33.0 ± 14.0 )% ( 14.5 %～ 52.2 %),coronary calcium deposits were detected by EBCT in 6 ( 31.6 %) segments of angiographically normal segments.Compared with CAG,EBCT yielded a sensitivity of 68.8 % and a specificity of 68.4 %.Compared with ICUS,an overall sensitivity of EBCT and CAG for detection of the atherosclerosis was both 64.0 %,the specificity was 90.0 % and 100% and the accuracy was 74.3 % and 71.4 %,respectively(P= 0.763 ).For plaques with and without ultrasound signs of calcifications,the sensitivity of EBCT was 92.3 % and 33.3 %,the specificity was 77.3 % and 43.5 %,the positive predictive value was 70.6 % and 23.5 %,the negative predictive value was 94.4 % and 55.6 %,and the accuracy was 82.9 % and 40%.Conclusions ①EBCT and ICUS imaging may be helpful to identify the atherosclerotic plaques in angiographically normal artery or underestimated lesions.②As compared with ICUS,there was no significant difference for the detection of coronary atherosclerosis between CAG and EBCT.③EBCT detects calcified plaques with higher sensitivity and about one third of soft/fibrous plaques also can be detected.