冠状动脉计算机断层摄影术成像意外检出心外病变分析

Analysis of Extra-cardiac Findings by Coronary Computed Tomography Angiography in Patients With Suspected Coronary Artery Disease

目的:量化冠状动脉计算机断层摄影术成像(CCTA)心外病变的意外检出,并探讨其临床价值,提高对此类病变的认识。方法:2011-06至2013-03临床怀疑冠心病并接受CCTA检查的1 169例患者,入选患者共1 030例,其中住院患者589例,门诊患者441例;年龄≥60岁患者549例,<60岁481例。由三名医师在扩大扫描视野的图像采用相应窗宽和窗位对肺、纵隔、胸廓和上腹部等病变进行评价并记录病变检出结果。同时根据心外病变的临床意义进行评分:有意义病变组,包括1分为严重病变,需要立即采取治疗措施;2分为病变有临床及预后相关性,要求临床重视,需要随访和进一步检查明确诊断的病变。无意义病变组,包括3分为轻微病变,不需要随访和进一步检查。结果:1 030例患者中意外检出心外病变197例(19.1%),共224处,其中27例(2.6%)患者有2处病变。90/1 030例(8.7%)患者共106处有意义病变。其中肺癌意外检出3例(0.3%),肺动脉栓塞意外检出8例(0.8%)。107例患者共118处无意义病变。住院患者检出114/589例(19.4%),门诊患者检出83/441例(18.8%),差异无统计学意义(P>0.05)。年龄<60岁的患者心外病变检出76/481例(15.8%),年龄≥60岁的患者心外病变检出121/549例(22.0%),差异有统计学意义(P<0.05)。结论:不增加额外有效辐射剂量的情况下,在扩大扫描视野的CCTA上心外病变检出率为19.1%,其中有意义病变检出率为8.7%。每一位影像诊断医师都应常规利用CCTA评价是否存在心外病变。

Objective： To quantitatively study the incidental extra-cardiac findings （ECFs） by coronary computed tomography angiography （CCTA） in patients with suspected coronary artery disease （CAD） in order to better recognize those lesions in clinical practice. Methods： A total of 1169 suspected CAD patients received CCTA in our hospital from 2011-06 to 2013-03 and 1030 patients were enrolled in this study. There were 589 in-patients, 441 out-patients and 549 patients ≥ 60 years of age, 481 patients 〈 60 years of age. 3 physicians evaluated the incidental ECFs in the full field of view （FOV） in different window level and window width for lung, mediastinum, thorax and upper abdominal areas. Clinical relevance of ECFs were classified by corresponding scores. Score 1, the patients with severe lesion need immediate treatment, score 2, the lesion with clinical and prognostic significance and score 3, the finding without clinical significance. Results： There were 197/1030 （19.1%） patients having 224 ECFs and 27 （2.6%） patients having 2 ECFs; 90/1030 （8.7%） patients having 106 significant lesions including 3 （0.3%） of lung cancer and 8 （0.8%） of pulmonary embolism; 107 patients with 118 lesions without significance. ECFs were found in 114/589 （19.4%） in-patients and in 83/441 （18.8%） out-patients, ≥0.05; 76/481 （15.8%） of patients 〈 60 years of age and 121/549 （22.0%） of patients/〉 60 years, P〈0.05. Conclusion： Unexpected ECFs detection rate was 19.1% in patients undergoing CCTA without further radiation exposure by reconstruction with the full FOV setting, and 8.7% of ECFs had clinical significance. Radiologists should routinely analyze the extra-cardiac organs in CCTA.