多层螺旋CT冠状动脉成像中源图像对冠状动脉以外病变的诊断价值

Clinical value of multi-detector computed tomography source image on detecting extracoronaryabnormalities

目的评价多层螺旋CT冠状动脉成像中源图像对冠状动脉以外病变的诊断价值。方法回顾性分析3240例进行冠状动脉检查的患者，由2名放射科医师对源图像进行分析，并记录肺窗、纵隔窗及骨窗观察的结果，按冠状动脉以外病变发生的部位进行病变统计，包括肺、腹部、纵隔、血管、骨及胸廓病变。同时按冠状动脉以外病变的临床意义进行评分：有临床意义组，包括1分为危及生命，需采取紧急措施的病变；2分为病变有临床及预后相关性，要求临床重视，需进一步进行检查和随访的病变；无临床意义组，包括3分为不需要进行进一步检查和随访的病变。不相关的病变（如主动脉粥样硬化、椎体退行性改变）未纳入统计。分别统计各种冠状动脉以外病变的发生率，并用肺窗、纵隔窗及骨窗分别进行观察，以及冠状动脉病变与冠状动脉以外病变的相关性。结果3227例患者中发现330例（10．2％）有424个冠状动脉以外病变。20．3％（67／330）患者有多部位病变，其中16．5％（70／424）发生于肺组织，13．2％（56／424）发生于腹部，56．8％（24l／424）发生于纵隔，0．9％（4／424）发生于骨及胸廓，13．9％（53／424）是血管性病变。在纵隔病变中胸腔积液发生率为6．3％（24／380）。冠状动脉以外心脏病变包括心腔扩大、心脏瓣膜病变、心包积液和（或）钙化、心房和（或）心室充盈缺损、心肌病、先天性心脏病和室壁瘤，发生率分别为14．7％（56／380）、15．5％（59／380）、10．8％（41／380）、3．9％（15／380）、0．8％（3／380）、1．6％（6／380）和1．8％（7／380）。临床意义评价结果，1、2、3分病变的发生率分别为8．5％（36／424）、81．1％（344／424）和10．4％（44／424）。用肺窗、纵隔窗及骨窗进行不同部位冠状动脉以外病变的观察差异有统计学意义（P均〈0．05）。冠状动脉与冠状动脉以外病变相关性不高（X2=81．76，C=0．155，P〉0．05）。2名医师观察有无冠状动脉以外病变的一致性非常好（Kappa值=0．934，P〉0．05）。结论冠状动脉cT成像源图像具有重要的临床诊断价值，可提示对临床有重要价值的冠状动脉以外病变。

Objective To assess the clinical value of multi-detector computed tomography （MDCT） source image on detecting extracoronary abnormalities in a large cohort of patients with suspected coronary artery disease （CAD）. Method MDCT source images from 3240 consecutive patients （mean 64. 5 years ） with suspected CAD were reviewed retrospectively by 2 readers. Extra-coronary findings were classified according to involved organ and level of clinical significance. Following organs were examined：lungs, upper abdomen, spine, chest wall, mediastinum and vascularatures. Clinical relevance of extracoronary findings was considered as either ＂significant＂ or ＂non-significant＂. ＂Significant＂ findings were subclassified as score 1 ：findings necessitating immediate therapeutic actions, or score 2：findings with uncertain clinical or prognostic relevance, requiring clinical awareness, follow-up or further investigations （non-urgent）. ＂Non- significant＂ findings were assigned to score 3：findings without clinical implication. The irrelevant incidentalfindings （e. g. spinal degenerative changes, aortic calcification） were not analyzed. Results Extracoronary findings was evidenced in 330 patients with 424 abnormalities, 20. 3% （ 67/330 ） patients had multiple lesions, 16. 5% lesions were located in the lungs, 13.2% lesions found in the upper abdomen,56. 8% （241/424） lesions evidenced in the mediastinum, 0. 9% （4/424）lesions seen in the spine and chest wall, 13.9% （53/424） lesions were related to other vascular disease. Pleural effusion accounts for 5.5% of the mediastinnm lesions. Incidence of heart cavity enlargement, heart valve disease, pericardial effusion/ calcification, atrial/ventricular perfusion defects, myocardial disease, congenital heart disease, ventricular aneurysmwas 14. 7% （56/380）, 15.5% （59/380）, 10.8% （41/380）, 3.9% （15/380）, 0.8% （3/380）, 1.6% （6/380） , and 1.8% （7/380） respectively. The clinical significance score 1-3 was 8.5% （36/424）, 81.1% （ 344/424 ）, and 10.4% （ 44/424 ） respectively. Incidence of detected extracoronary findings was the highest by bone window and the lowest by lung window. Incidence of extarcoronary findings was not related to CAD （X2 = 81.76, C = 0. 155, P 〉 0. 05 ）. Inter-reader agreement on extracoronary findings was excellent （ Kappa = 0. 934, P 〉 0. 05 ）. Conclusion Our data show that it is of clinical value to observe and report extracoronary findings with source image of cardiac MDCT.