心肌灌注显像联合冠状动脉钙化积分一站式检查对冠心病的诊断价值

One-step Examination of Myocardial Perfusion Imaging Combined with Coronary Artery Calcium Score in Diagnosis of Coronary Artery Disease

目的心肌灌注显像(MPI)联合冠状动脉钙化积分(CACS)一站式检查可同时获得冠状动脉功能信息和解剖信息,本研究探讨MPI联合CACS一站式检查对冠心病(CAD)的诊断价值。资料与方法回顾性分析行MPI联合CACS一站式检查及冠状动脉造影(ICA)的188例可疑CAD患者,以ICA结果作为诊断"金标准",分析MPI、CACS及两者联合对CAD的诊断效能。结果 1 188例疑似CAD患者中CAD验前概率中度可能者150例(79.8%),高度可能者38例(20.2%)。ICA诊断为CAD 73例,非CAD 115例。2 MPI诊断CAD的敏感度、特异度、准确度、阳性预测值、阴性预测值分别为65.8%、75.7%、71.8%、63.1%、77.7%。3 CAD组CACS明显高于非CAD组[(494.96±99.60)分比(38.15±16.03)分,P<0.05]。根据受试者操作特征曲线,CACS诊断CAD的最佳界值为96.45分,以CACS≥96.45分作为诊断CAD的标准,其诊断CAD的敏感度、特异度、准确度、阳性预测值、阴性预测值分别为60.3%、93.9%、80.8%、86.3%、78.8%。4 MPI联合CACS诊断CAD的敏感度高于MPI(80.8%比65.8%,P<0.05),其特异度(71.3%比75.7%)和准确度(75.0%比71.8%)差异无统计学意义(P>0.05);MPI联合CACS诊断CAD的敏感度高于CACS(80.8%比60.3%,P<0.05),特异度低于CACS(71.3%比93.9%,P<0.05),其诊断准确度(75.0%比80.8%)差异无统计学意义(P>0.05)。结论 MPI联合CACS一站式检查可减少单用MPI或CACS对CAD的漏诊,提高CAD的诊断敏感度,对CAD中度可能患者的诊断具有重要价值。

Purpose The one-step examination of myocardial perfusion imaging（MPI） combined with coronary artery calcium score（CACS） can obtain both coronary functional information and anatomical information simultaneously, this paper aims to evaluate the value of the one-step examination of MPI combined with CACS for detecting coronary artery disease（CAD）. Materials and Methods 188 cases who underwent onestep examination of MPI combined with CACS and invasive coronary angiography（ICA） because of chest tightness, chest pain with suspected coronary artery disease were analyzed retrospectively, with the results of ICA used as ＂gold standard＂, the diagnostic efficacy of MPI, CACS and one-step examination with combination of the two techniques for CAD was investigated. Results 1 Pre-test probability of CAD was intermediate in 79.8%（150/188）, and high in 20.2%（38/188） cases. Seventy-three cases were confirmed as CAD and 115 of 188 patients were negative according to ICA. 2 The sensitivity, specificity, accuracy, positive predictive value（PPV） and negative predictive value（NPV） for the diagnosis of CAD by MPI were 65.8%, 75.7%, 71.8%, 63.1% and 77.7%, respectively. 3 The CACS of CAD group was significantly higher than the non-CAD group（494.96±99.60 vs. 38.15±16.03, P〈0.05）. According to the features of the ROC curve, the best threshold for the diagnosis of CAD with CACS was 96.45, with CACS ≥ 96.45 as the positive standard in diagnosis of CAD, the sensitivity, specificity, accuracy, PPV and NPV for the diagnosis of CAD by CACS were 60.3%, 93.9%, 80.8%, 86.3% and 78.8%, respectively. 4 The sensitivity of MPI combined with CACS were significantly higher than MPI（80.8% vs. 65.8%, P〈0.05）, while the specificity（71.3% vs.75.7%, P〈0.05） and accuracy（75.0% vs. 71.8%, P〈0.05） showed no statistically significant difference; the sensitivity of MPI combined with CACS were significantly higher than CACS（80.8% vs. 60.3%, P〈0.05）, while the specificity was lower than CACS（71.3% vs. 93.9%, P〈0.05） and the accuracy showed no statistically significant difference（75.0% vs. 80.8%, P〈0.05）. Conclusion The one-step examination of MPI combined with CACS can reduce coronary heart disease misdiagnosis, improve the diagnostic sensitivity of CAD compared with the MPI or CACS, with high application value for the diagnosis of CAD, especially in moderate risk groups.