双源CTA在不控制心率患者冠状动脉斑块评价中的价值探讨

The Value of Dual-source CTA in Evaluation of the Coronary Artery Plaques without Heart Rate Control

目的:探讨不控制心率情况下双源CTA在冠状动脉狭窄分级及斑块分析中的应用价值。方法 :回顾性分析我院2014年5月～2017年12月期间同时接受冠状动脉CTA和CAG检查的33例住院患者,共537个节段。每个节段按正常、轻度狭窄、中度狭窄、重度狭窄分别进行CTA、CAG分级,然后比较CTA与CAG一致性,以CAG为参考标准,计算CTA准确率。根据CTA血管分析,对冠状动脉斑块进行分类及定位、定性诊断。结果 :CTA共有470节段狭窄分级与CAG一致,总的准确率为87.5%。R×C列联表一致性卡方检验显示CTA与CAG具有高度一致性,其列联系数r=0.913,Kappa系数为0.742。169个节段狭窄斑块中,左前降支发生率最高,共26个节段,占比15.4%。斑块类型中混合斑块发生率最高,共73个节段,占43.2%。定性诊断结果显示,稳定斑块103节段,占60.9%,易损斑块66节段,占39.1%,其中正性重构13节段,低密度斑块15个节段,点状钙化3个节段,正性重构+低密度斑块14个节段,正性重构+餐巾环征17个节段,正性重构+点状钙化4个节段。结论:在不控制心率的情况下,Siemens第二代双源CTA对斑块引起的血管狭窄分级具有高准确率,可以对斑块进行分类及定位、定性诊断,为临床提供综合的及预后的信息,从而与适当的预防性、治疗性干预措施联系起来。

Purpose: To investigate the value of dual-source CTA in the evaluation of degree of coronary artery stenosis and plaque analysis without heart rate control. Methods: A retrospective analysis were performed in 33 consecutive patients who underwent coronary artery CTA and CAG examinations simultaneously during the period of May 2014 to December 2017, with a total of 537 segments. According to the stenosis degree, each segment was divided into normal, mild stenosis, moderate stenosis and severe stenosis respectively, and then the consistency of CTA and CAG was compared. CAG was used as the reference standard to calculate the accuracy of CTA. According to the CTA vascular analysis, the coronary atherosclerotic plaques were classified, located and qualitatively diagnosed. Results: The stenosis degree of CTA and CAG were consistent in 470 segments, with a total coincidence rate of 87.5%. The R×C contingency table consistency chisquare test showed that CTA and CAG had a high consistency, its coefficient r=0.913, and the Kappa coefficient was 0.742. Of 169 segments of plaques which caused coronary of the Coronary Artery Plaques without Heart Rate Control FANG Chang-hai1, SHU Tian-xiao2, MEI Yao1, ZHANG Ti-xin1, LIU Dong-hua1 The Value of Dual-source CTA in Evaluation artery stenosis, the incidence of the left anterior descending branch was the highest, which was totally 26 segments, accounting for 15.4%. According to classification, the incidence of mixed plaques was the highest, which was totally 73 segments, accounting for 43.2%. The results of qualitative diagnosis showed that 103 segments of plaques were stable, accounting for 60.9%; and 66 segments of plaques were vulnerable, accounting for 39.1%, 13 of them were with positive remodeling, 15 with low density plaques, 3 with spotty calcification, 14 with positive remodeling plus low density plaque, 17 with positive remodeling plus napkin ring sign, and 4 with positive remodeling plus spotty calcification. Conclusion: Without heart rate controls, Siemens second generation double source CTA had high accuracy in evaluation of the degree of coronary artery stenosis caused by plaques, and the plaques could be classified, located, and qualitatively diagnosed. Comprehensive information for clinical prognosis, appropriate preventive and therapeutic interventions can also be obtained.