双源CT冠状动脉斑块成像在冠心病临床分型的价值

Dual-source CT Coronary Artery Plaque in Evaluating Clinical Types of Coronary Heart Diseases

目的采用双源CT(DSCT)冠状动脉成像(CCTA)与血管内超声(IVUS)评估斑块形态学及成分与冠心病临床类型的关系。资料与方法 35例冠心病患者行CCTA与IVUS检查,比较两种检查测量的病变部位血管面积、斑块面积、最小管腔面积、局部面积狭窄率、血管重构指数(RI)、斑块偏心指数(EI);以IVUS检查为标准分析斑块的性质;根据临床标准将患者分为急性冠状动脉综合征(ACS)组和稳定型心绞痛(SAP)组,比较两组斑块的性质及血管RI、斑块EI。结果 35例患者共59支为病变血管,其中病变节段200段,以DSCT与IVUS共同测量146个病变节段的血管面积、管腔面积、斑块面积、狭窄程度、RI及EI,差异均无统计学意义(P>0.05);ACS组及SAP组脂质斑块、钙化斑块节段数目(χ2=20.527、14.582,P<0.05)、斑块偏心性(χ2=42.575,P<0.05)及血管重构(χ2=21.489、1.724、14.184,P<0.05)方面差异均有统计学意义。结论 DSCT与IVUS在冠状动脉斑块的检测方面具有一致性,ACS多为脂质斑块,斑块多呈偏心性分布,病变血管存在正性重构。

Purpose To evaluate the correlation between plaque morphology and composition with the clinical types of coronary heart disease using dual-source CT （DSCT） coronary angiography （CCTA） and intravascular unltrasound （IVUS）. Materials and Methods Thirty-five patients confirmed as coronary heart disease underwent CCTA and IVUS examination, area of lesion vessel, plaque area, minimal lumen area, local area stenosis rate, vascular remodeling index, and plaque eccentricity index measured by the two different examination methods were compared; plaque character of all subjects was analyzed using IVUS as reference standard. All the subjects were divided into acute coronary syndrome （ACS） group and stable angina pectoris （SAP） group by clinical standards, then plaque composition, remodeling index （RI） and eccentric index （El） of the two groups were compared. Resdts For the 105 vessels in 35 cases, 59 branches with 200 lesion segments, differences of the results measured from DSCT and IVUS were not statistically significant （P〉0.05）; while differences of lipid plaque, calcified plaques （χ2=20.527 and 14.582, P〈0.05）, El （χ2=42.575, P〈0.05） and RI （χ2=21.489, 1.724 and 14.184, P〈0.05） between the ACS group and SAP group were statistically significant. Conclusion There is a good consistency between DSCT and IVUS for the evaluation of coronary plaques, and most of the segments with ACS are lipid plaques with eccentric distribution and positive remodeling.