双源CT冠状动脉成像对冠状动脉狭窄的临床诊断分析

Diagnosis analysis of dual source CT coronary artery angiography on detecting coronary artery stenosis

目的与选择性冠状动脉造影(SCAG)对照,探讨双源CT(DSCT)对冠状动脉狭窄(≥50﹪)的诊断价值,分析其误诊原因。方法回顾性分析在我院行DSCT冠状动脉及SCAG成像的受检者199例,分析比较DSCT诊断冠状动脉狭窄(≥50﹪)的敏感性、特异性及准确性。结果在199例受检者中,共发现2656段冠脉血管段、792条分支;DSCT与SCAG对冠状动脉狭窄(≥50﹪)的诊断两者间差异无统计学意义(P>0.05);双源CT在以血管段、血管分支及受检者为单位诊断冠状动脉狭窄(≥50﹪)的灵敏度、特异度、准确度分别为90.38﹪、97.05﹪、95.75﹪;92.65﹪、97.04﹪、95.45﹪;94.12﹪、78.26﹪、90.45﹪。在以冠脉血管段为单位评估冠脉狭窄(≥50﹪)时,共误诊63血管段,漏诊50血管段,误诊原因主要由于重度钙化,髙心率或心律失常及最佳绝对时相选择的错误,漏诊原因主要由于人为疏忽或技术原因。结论相比较SCAG,DSCT在对冠状动脉狭窄(≥50﹪)的诊断存在一定程度的误诊,但两者间差异无统计学意义,DSCT可作为冠心病筛查的重要手段。

Objective Compared with SCAG, to evaluate the application value of dual source computed tomography coronary angiography on detecting coronary artery stenosis （〉 50 % ） compared with SCAG, and analysis the misdiagnosis reason. Methods 199 subjects were analyzed retrospectively with DSCT coronary artery angiography and SCAG examination in our hospital. The sensitivity, specificity and accuracy of DSCT on the diagnosis of coronary stenosis （〉 50 % ） was analyzed and compared. Result In the 199 cases, 2656 segments of coronary arteries and 792 vascular branch were found.There were no significant difference in the diagnosis of coronary artery stenosis （〉 50 % ） between DSCT and SCAG, when put vascular segment、 vascular branche, and subject as the unit （P 〉 0.05）, its corresponding Se、 Sp and accurancy is respectively 90.38 %, 97.05 % 、 95.75 %; 92.65 % 、 97.04% 、 95.45 %; 94.12% 、 78.26% 、 90.45 %. 63 vascular segments were misdiagnosised and 50 missed in the diagnosis of coronary artery stenosis （〉 50 % ） when put vascular segment as the unit. The main causes of misdiagnosis is due to severe calcification, high heart rate or arrhythmia and the optimal absolute phase selection error, and the cause of missed diagnosis is mainly due to Human negligence or technical performance reasons. Conclusion Compared with SCAG, DSCT exists certain degree of fault diagnosis in coronary artery stenosis （〉 50 % ） diagnosis ,but there was no statistically significant difference between DSCT and SCAG. DSCT can be used as an important means of screening for coronary artery disease.