应用受试者工作特征曲线分析256层CTA诊断冠状动脉狭窄的价值

Diagnostic value of 256-slice CT angiography for detecting coronary artery stenosis:ROC curve analysis

目的：结合受试者工作特征（receiver operating characteristic,ROC）曲线探讨256层CTA在冠状动脉成像及冠状动脉狭窄诊断中的价值.方法：与DSA对照,回顾性分析100例拟诊冠心病患者CTA检查结果.根据心率,将患者随机分为3组：低心率组40例,心率＜75次/min;中等心率组35例,75次/min≤心率＜90次/min;高心率组25例,心率≥90次/min.统计学分析采用多个独立样本非参数检验、ROC分析和One-Way ANOVA方法.结果：100例心率范围（39~107）次/min,平均（76.44±13.36）次/min.全部1 500冠脉节段中,CTA显示1 447个节段（96.47%）;可以满足诊断者1 403个节段（占96.96%）,其中低心率组97.76%、中等心率组96.86%、高心率组95.80%,不同心率组间图像质量评分比较P＞0.05,差异无统计学意义.ROC曲线分析,低、中、高心率组CTA诊断冠状动脉狭窄的特异性分别为98.40%、96.00%、97.60%,敏感性95.00%、93.70%、92.20%,曲线下面积值0.971、0.955、0.955,3组比较P＞0.05,差异无统计学意义.结论：256层CTA可在一定程度上不受心率的限制行冠状动脉成像,并且能够清晰地显示冠状动脉的主要节段,较为准确地诊断冠状动脉狭窄.

Objective：To discuss the value of 256-slice spiral CT angiography （CTA） for detecting coronary artery stenosis with ROC curve. Methods：One hundred patients suspected of coronary heart disease underwent 256-slice CTA examination. CTA re- suits was retrospectively analyzed and compared with those of coronary artery angiography （CAG）. All cases were divided into three groups randomly： forty cases with HR〈75 beats per minute （bpm） were included as Low H R group, twenty five cases with HR≥90 bpm were included as High HR group, and thirty five cases with HR≥75 bpm and 〈90 bpm were middle HR group. All statistical analyses were performed using SPSS K-Independent Samples Test, ROC curve and One-Way ANOVA. Re- suits：For all cases,the value of HR was （76. 44＋13.36） bpm between 39 bpm and 107 bpm. In 1500 segments of 100 cases, 1403（96. 95%） segments were considered diagnostic of 1447（96.47%） segments shown with CTA examination. For three groups,the proportion of segments considered diagnostic was 97.76% in Low HR group, 96.86% in middle HR group and 95.80% in High HR group. There was no statistical difference of image quality among three groups. According to ROC curve, the specificity of CTA in diagnosing coronary artery stenosis was 98.40%, 96.00%, 97.60% in Low HR group, middle HR group and High HR group. The sensitivity was 95.00%, 93.70%, 92.20%0 and the value of Az was 0. 971,0. 955,0. 955. A- mong three groups,there was no statistical difference of results in diagnosing coronary artery stenosis with CTA. Conclusion.- 256-slice CTA image can be applied to coronary artery suitably without confinement of HR to some degree,to display coronary artery main segments clearly and diagnose coronary artery stenosis exactly.