双源螺旋CT冠状动脉成像和造影对老年人冠状动脉病变的诊断价值

Diagnostic value of dual-source spiral CT of coronary artery imaging versus coronary angiography in the elderly with coronary artery lesions

目的以常规冠状动脉（冠脉）造影为金标准评价双源CT（DSCT）对老年冠心病患者冠脉病变的诊断价值。方法对129例入选老年疑诊冠心病患者进行DSCT和冠脉造影两种血管成像检查，将冠脉造影结果作为金标准，同一患者前后自身对照，评价DSCT冠脉成像基于冠脉主干、基于血管分支和基于血管节段对冠状动脉狭窄病变的敏感性、特异性、阳性预测值、阴性预测值和准确度。结果本研究129例患者中，冠脉造影诊断为冠心病102例，DSCT评估冠脉病变的敏感性为98．0％（100／102），特异性为81．5％（22／27），阳性预测值为95．2％（100／105），阴性预测值为91．7％（22／24），诊断准确性为94．6％（122／129）。在对976支冠脉分支血管进行对比分析中，冠脉造影诊断有狭窄的血管544支，而DSCT诊断有狭窄的血管549支，DSCT评估冠脉狭窄的敏感性为90．1％（490／544），特异性为86．3％（373／432），阳性预测值为89．3％（490／549），阴性预测值为85．4％（373／437），诊断准确性为88．4％（863／976）。基于节段的分析，1493个节段，冠脉造影共诊断805个节段有狭窄，DSCT共诊断849个节段有狭窄，DSCT评估冠脉狭窄的敏感性为91．1％（733／805），特异性为83．1％（572／688），阳性预测值为86．3％（733／849），阴性预测值为88．8％（572／644），诊断准确性为87．4％（1305／1493）。配对χ^2检验显示基于节段分析时，两种检查方法在诊断冠脉狭窄程度比较差异有统计学意义（P〈0．01）。结论DSCT能够在患者水平和血管水平较准确地评估不同程度的冠脉狭窄；但就本组病例基于节段分析中，DSCT与冠脉造影在诊断冠脉狭窄程度上差异有统计学意义，因此尚不能完全取代常规冠脉造影。

Objective To evaluate the diagnostic value of dual-source CT （DSCT） in the elderly with coronary heart disease （CHD）, taking the conventional coronary angiography （CAG） as the gold standard. Methods 129 elderly patients with suspected diagnosis of CHD were selected to conduct two kinds of vascular imaging DSCT and CAG, with the CAG results as the gold standard. DSCT coronary artery imaging was evaluate by the sensitivity, specificity, positive predictive value, negative predictive value and accuracy based on patients, blood vessels and the section of coronary artery stenosis. Results 102 cases were diagnosed as coronary heart disease by CAG. The sensitivity of coronary lesions diagnosed by DSCT was 98.0% （100/102）, specificity was 81.5% （22/27）, positive predictive value was 95.2% （100/105）, negative predictive value was 91.7% （22/24）, and diagnostic accuracy was 94. 60% （122/129）. In 976 coronary artery branch blood vessels, 544 vessels were diagnosed as stenosis by CAG, while 549 vessels were diagnosed as stenosis by DSCT. The sensitivity of coronary artery stenosis diagnosed by DSCT was 90.1% （490/544）, specificity was 86.3 % （373/ 432）, positive predictive value was 89. 3% （490/549）, negative predictive value was 85.4% （373/ 437）, and diagnostic accuracy was 88. 4% （863/976）. Based on the segmental analysis, in 1493 segments, 805 segments were diagnosed as stenosis by CAG, while 849 segments were diagnosed as stenosis by DSCT. The sensitivity of coronary artery stenosis diagnosed by DSCT was 91.1% （733/ 805）, specificity was 83. 1% （572/688）, positive predictive value was 86. 3% （733/849）, negative predictive value was 88. 8% （572/644）, and the diagnostic accuracy was 87. 4% （1305/1493）. Matching χ squared test shows that based on the segmental analysis, two checking methods in the diagnosis of coronary artery stenosis degree had a significant difference （P 〈 0.01）. Conclusions DSCT can accurately evaluate the coronary artery stenosis with different degree based on patient and blood vessel. But in this case based on the segmental analysis, DSCT and the CAG has a significant difference in the diagnosis of coronary artery stenosis degree, therefore DSCT cannot completely replace the conventional coronary angiography.