冠脉钙化程度对256层螺旋CT诊断冠脉狭窄病变的影响

Impacts of coronary artery calcium on the diagnostic accuracy in detecting stenosis using 256-slice CT

目的:评价和分析冠脉钙化对256层螺旋CT冠脉成像(CTA)诊断冠脉狭窄病变的影响。方法:收集接受256层螺旋CTA检查并同时做钙化积分扫描的51例疑似冠心病患者的相关资料,所有患者30d内均进行了选择性冠脉造影(CAG)检查。采用ROC曲线分析钙化积分对256层螺旋CTA诊断冠脉狭窄(≥50%)准确性的影响。结果:基于分血管节段后(共计663段血管),将51例患者分为2组:钙化积分<100为较轻钙化组,计260段血管(20例),钙化积分≥100为较重钙化组,计403段血管(31例)。256层螺旋CTA诊断较轻钙化组的敏感性为53.49%,特异性为97.24%,ROC曲线下面积(AUC)为0.754(P<0.05);诊断较重钙化组的敏感性为64.95%,特异性为90.52%,AUC为0.768(P<0.05)。结论:256层螺旋CTA诊断较重钙化的冠脉狭窄病变敏感性增加,特异性下降,但其诊断价值未受影响。

Objective To investigate the impacts of coronary artery calcium on the diagnostic accuracy in detecting stenosis by 256-slice computed tomographic angiography （CTA）. Methods Detail information was collected from 51 suspect patients with coronary arteries, which received the 256-slice CTA diagnosis and calcium score scanning. Then, all the patients received the coronary arteriongraphy （CAG） in a month. The impacts ofcoronary artery calcium score on the diagnostic accuracy （stenosis≥ 50%） of 256-slice CTA was evaluated by ROC curves. Results Calculations for accuracy were conducted on a segmental basis including 663 comparable segments. 51 patients were divided into mild calcification group and severe calcification group. The mild calcification group with coronary artery calcium score 〈 100 offers 260 segments （20 patients）; The severe calcification group with coronary artery calcium score/〉 100 offers 403 segments （31 patients）. The sensitivity, specificity and areas under curve （AUC） of 256-slice CTA to detect coronary stenosis with mild calcification were 53.49%, 97.24% and 0.754 （P 〈 0.05）, respectively; the sensitivity, specificity and AUC of 256-slice CTA to detect coronary stenosis with severe calcification were 64.95%, 90.52% and 0.768 （P 〈 0.05）, respectively. Conclusion In the diagnosis of coronary artery stenosis with severe calcification by 256-slice CTA, tbe sensitivity increased, but the specificity dropped. It was no significant effect on the diagnostic value.