冠状动脉CT造影对诊断冠脉不同类型斑块所致管腔狭窄的准确性研究

Study on the Correlation between Coronary Atherosclerotic Plaques and Coronary Stenosis by Coronary CT Angiography

目的：评价冠状动脉CT造影（CCTA）诊断不同类型的冠状动脉粥样斑块所致冠状动脉狭窄的价值与限度。方法：连续80例完成CCTA及侵入性冠状动脉造影（ICA）检查的疑诊冠状动脉狭窄患者（男性62例，女性18例，年龄30-77岁，平均58岁）纳入研究，冠状动脉粥样斑块类型分为钙化性、非钙化性和混合性。以冠状动脉节段为单位，以ICA结果为金标准，运用相关分析及Bland-Altman分析评价2种检查技术诊断三种斑块所致冠状动脉狭窄的一致性。结果：最终诊断明显冠脉狭窄（狭窄程度≥50％）49例108个节段；两种技术诊断钙化斑块性冠状动脉明显狭窄一致性差（r=0．720，P〈0．01），非钙化和混合斑块性明显狭窄一致性良好（r=0．895，r=0．900，P〈0．01）。结论：CCTA诊断非钙化性和混合性斑块所致冠状动脉狭窄准确性较好，钙化斑块性狭窄的诊断需慎重．

Purpose： The purpose of this study was to test the value and limit of coronary CT angiography in detecting coronary stenosis with three types of coronary atherosclerotic plaques. Methods： Eighty patients underwent coronary CT angiography （CCTA） and invasive coronary angiography （/CA） were included in the study. Coronary artery plaques were classified as calcified, non-calcified and mixed plaques based on CCTA. Results： For calcified plaques, quantitative coronary stenosis analysis revealed a poor agreement between CCTA and ICA （r = 0.72）. For non-calcified and mixed plaques, quantitative coronary stenosis analysis revealed a good agreement between CCTA and ICA （r = 0.895, r = 0.900, respectively）. Conclusion： CCTA has good accucary in diagnosis of coronary stenosis caused by non-calcified and mixed plaques. An initial unenhanced scan to evaluate the presence of extensive calcium could avoid suboptimal CCTA in patients with severe calcifications.