64排螺旋CT冠脉成像(CTA)在冠心病诊断中的应用价值分析

An analysis of application value of CTA in diagnosis of CHD

目的评价64排螺旋CT冠脉成像(CTA)在冠心病诊断中的应用价值,总结应用经验。方法 2013年2月-2015年2月,341例疑似或确诊的冠心病进行CT冠脉成像(CTA),以冠状动脉造影为"金标准"。结果血管段显示率93.14%,显像不佳节段集中在OM、PD、D1、LCX2、LAD3、RCX2等处;CTA诊断冠心病阳性率90.81%(168/185)、阴性率86.54%(135/156)、阳性预测值88.89%(168/189)、阴性预测值88.82%(135/152)、符合率88.86%(303/341);CAG、CTA诊断管腔狭窄水平一致性系数k=0.892;CTA诊断狭窄灵敏度从高到低分别为RCA、LAD、LCX、LM,特异度从高到低分别为LM、LXX、LAD、RCA,准确率从高到低分别为LM、LAD、LCX、RCA;CAG评价2605段血管分支,其中管腔正常、轻度狭窄、中度狭窄、重度狭窄混合斑块率分别为38.83%(37/120)、27.61%(1311/862)、74.08%(626/845)、62.92%(207/329),差异具有统计学意义(P<0.05)。结论 CTA诊断冠心病效用较高,还可用于斑块评价,但在部分血管段显像效果不佳,成像质量影响因素较多。

Objective To evaluate application value of 64 row CT coronary angiography （CTA） in diagnosis of coronary heart disease （CHD） and share application experience. Methods 341 patients with suspected or determined CHD received CTA in our hospital over a period from Feb. ,2013 to Feb. ,2015 and coronary arteriography （CA） is regarded as a golden index of the diagnosis. Results The display rate of the vascular segment was 93.14% and the unclear dis- play vascular segment concentrated in QM, PD,D1, LCX2, LAD3 and RCX2 segments. The positive rate of CTA for di agnosis of CHD was 90.81% （168/185）and the negative rate was 86.54% （135/156）. The positive predictive value was 88.89%（168/189）and the negative predictive value was 88.82% （135/152） with 88.86% （303/341）of diagnostic ac- cordance rate. The diagnostic uniformity coefficient K value of CAG and CTA for luminal narrow severity was 0. 892. The higher diagnostic sensitivity of CTA for luminal narrow of vascular segment was RCA, LAD, LCX and LM respec tively in order,the higher specificity was LM, LXX, LAD and RCA respectively in order and the higher accuracy was LM,LAD,LCX and RCA respectively in order. Totally, 2605 vascular segments or branches were evaluated by using CAG, of which, the occurrence rates of the mixed atherosclerotie plaques in normal lumen, mildly narrowed lumen, mod- erately narrowed lumen and severely narrowed lumen were 38.83% （37/120） ,27.61% （1311/862） ,74.08% （626/845）, 62.92%（207/329）respectively,and there was a significant difference（P〈0.05）. Conclusion CTA has a high diagnos- tic value for CHD. Also,it can be applied in evaluation of atherosclerotic plaques. However, for some segments of coro- nary artery,the display effect is worse and the imaging quality is affected by many factors.