双源CT与冠状动脉造影评估冠状动脉狭窄对照研究

Dual source CT coronary angiography and selective coronary angiography for evaluation of coronary artery stenosis: a control study

目的探讨双源CT血管造影（DSCTA）诊断冠状动脉狭窄的准确性。方法 2012年11月至2013年11月对210例冠状动脉病变患者作DSCTA检查及选择性冠状动脉造影（CAG）检查,以CAG为金标准,评价DSCTA诊断冠状动脉狭窄的准确性。选取DSCTA和CAG检查后均接受前降支支架植入术患者各30例,对比造影体位、介入操作时间和对比剂使用剂量。结果 DSCTA检查210例患者2 630节段冠状动脉有不同程度狭窄或闭塞,与CAG检查比较,诊断灵敏度、特异度、阳性预测值、阴性预测值分别为95.4%、96.2%、91.3%、100%,两种方法间差异无统计学意义（P=0.066）。DSCTA造影体位2-3个、介入操作时间约15 min、对比剂使用剂量为48 ml（30-150 ml）,分别比CAG减少2-4个、缩短约10 min、减少一半。结论 DSCTA诊断冠状动脉狭窄病变准确性高,近似于CAG,是一种安全可靠的无创检查方法。术前DSCTA检查可减少术中患者造影体位及对比剂使用剂量,缩短介入治疗时间,达到减少医源性放射性辐射的目的。

Objective To evaluate the diagnostic accuracy of dual source CT angiography（DSCTA）for coronary artery stenosis. Methods During the period from November 2012 to November 2013, a total of210 patients with coronary artery disease underwent DSCTA and selective coronary arteriography（CAG）.Taking CAG as the gold standard, the diagnostic accuracy of DSCTA for coronary artery stenosis was evaluated. Thirty patients receiving DSCTA and 30 patients receiving CAG were selected, and all of them underwent stent implantation in the anterior descending branch after imaging examination. The angiography positions, the used time of PCI and the used dosage of contrast agent were compared between the two groups.Results DSCTA was performed in 210 patients and a total of 2 630 segments of coronary stenosis or occlusion were detected. Compared with CAG, the diagnostic sensitivity, specificity, positive predictive value and negative predictive value of DSCTA were 95.4%, 96.2%, 91.3% and 100% respectively, which were not significantly different from those obtained by CAG（P =0.066）. In performing DSCTA, 2-3 angiography positions were used（2-4 positions less than that of CAG）, the used time of PCI was about 15 min（about10 min less than that of CAG）, and the mean used dosage of contrast agent was 48 ml（30-150 ml）（about half less than that of CAG）. Conclusion DSCTA has higher accuracy in diagnosing coronary artery stenosis,quite similar to that of CAG. DSCTA is a safe, reliable and noninvasive examination method. Preoperative DSCTA can reduce exposure positions during angiography, can reduce the dosage of contrast agent, and can shorten the time of PCI as well, thus, iatrogenic radioactive radiation dose can be reduced.