多层螺旋CT判断冠状动脉斑块性质与狭窄程度的相关性研究

Study on Correlation between Coronary Plague Property and Degree of Stenosis by Multi-slice Spiral Computed Tomography Coronary Angiography

目的应用40层螺旋CT冠状动脉成像（CTCA），探讨冠脉病变患者斑块性质与管腔狭窄之间的相关性，为临床正确判断冠心病提供可靠依据。方法回顾性分析68例行CTCA检查患者，由2名经验丰富放射科医生按非钙化斑块、混合斑块、完全钙化斑块进行管腔狭窄评价，与冠状动脉造影（CAG）结果进行对比分析，以CAG结果为金标准，得出CTCA不同性质斑块对于判断管腔狭窄的敏感性、特异性、阳性预测值和阴性预测值，进而评价斑块性质对判断冠状动脉管腔狭窄的影响。结果共分析了509个冠脉节段，发现病变节段196个（38．51％），其中非钙化斑块66个（33．67％），混合性斑块52个（26．53％），完全钙化斑块78个（39．80％）。在造成冠状动脉中重度狭窄（≥50％）的节段中，非钙化斑块及混合斑块的敏感性和阳性预测值较高，均〉90％；完全钙化斑块的敏感性和阳性预测值相对较低，分别为83．33％和55．56％。在管腔轻度狭窄（〈50％）时各种斑块均有较高的敏感性和阳性预测值，均〉90％。结论冠状动脉CT血管成像能显示不同性质的斑块，并能判断管腔狭窄程度。在管腔轻度狭窄时，不同性质斑块均能作出较准确的判断；管腔中重度狭窄时，对于非钙化性斑块及混合斑块造成的狭窄能作出可靠的判断，但完全钙化斑块造成的狭窄易过度评价，造成一定误判。

Objective To explore the correlation between the coronary plaque composition and the degree of stenosis by 40-slice CT coronary angiography（CTCA）,which can provide reliable evidence for clinical accurate diagnosis.Method 68 patients who undertook CTCA examination were analyzed retrospectively.The stenosis of coronary artery were assessed by 2 experienced doctors as non-calcified plaque,mixed plaque and fully-calcified plaque and were compared with coronary arteriongraphy（CAG）.SPSS 16.0 statistical analysis software was used to analyze the sensitivity, specitivity, positive predictive value and negative predictive value of the different CTCA property plaque for assessing coronary artery stenosis,in order to further evaluate the effect of the plaque property for assessing stenosis.Result 509 coronary segments were analyzed with 196 abnormalities.In between,66 cases for non-calcified plaque（33.67%）,52 for mixed plaque（26.53%）,78 for fully-calcified plaque（39.80%）.In the segments which result in the moderate and severe stenosis（ 〉 50%）,the sensitivity and positive predictive value of non-calcified plaque and mixed plaque were high as both 〉 90%,while the sensitivity and positive predictive value of fully-calcified plaque were relatively low as 83.33% and 55.56% respectively.Each plaque has high sensitivity and positive predictive value as all 〉 90% for mild stenosis（ 〈 50%）.Conclusion CT coronary angiography can show different composition plaque and has the ability to judge the extent of the coronary artery stenosis.It can make accurate judgement for each property plaque when mild stenosis;For non-calcified plaque and mixed plaque it can make reliable judgement when moderate or severe stenosis,while it can make over-assessment for stenosis which caused by fully-calcified plaque and cause somehow misjudgement.