双源CT前瞻性心电门控低剂量扫描对PCI术后胸痛的诊断价值

Diagnostic Value of Dual-source CT Prospective Electrocardiographic Gated Low Dose Scan for Patients with Chest Pain After Percutaneous Coronary Intervention

目的探讨双源CT前瞻性心电门控低剂量扫描技术(DSCT)对经皮冠状动脉介入术(PCI)后胸痛患者的诊断价值。方法选取本院2014年7月至2015年6月就诊的84例PCI术后胸痛患者进行心胸联合DSCT扫描,并有2位资深的放射科医师对患者的冠状动脉实施靶重组,同时对图像质量进行评价,作出诊断。所有患者在DSCT扫描后的2周内均行冠状动脉造影术(CAG)。以CAG结果为"金标准",评估DSCT诊断PCI术后胸痛患者冠状动脉狭窄的特异性、敏感性、阴性预测值和阳性预测值。采用Kappa检验评估两种检查对冠状动脉狭窄评估的一致性。结果 DSCT诊断PCI术后胸痛患者冠状动脉狭窄的特异性、敏感性、阴性预测值和阳性预测值分别为85.5%、96.6%、94.6%、90.4%。DSCT与CAG诊断冠状动脉狭窄程度具有高度一致性(Kappa值=0.858)。DSCT的有效辐射剂量为4.67±0.87 m Sv。结论对PCI术后胸痛患者行DSCT冠状动脉成像能获取高质量的图像,评价冠状动脉狭窄程度准确,辐射剂量较低,值得临床推广。

Aim To investigate the diagnostic value of dual-source CT prospective electrocardiographic gated low dose scan technology（ DSCT） for patients with chest pain after percutaneous coronary intervention（ PCI）. Methods84 patients with chest pain following PCI underwent DSCT from July 2014 to June 2015 in our hospital. Two independent experienced radiologists evaluated the image quality,and the images were target reconstructed on coronary arteries. All patients underwent coronary angiography（ CAG） within 2 weeks after DSCT scan. CAG results were as the ＂gold standard＂,and the specificity,sensitivity,negative predictive value and positive predictive value of DSCT were assessed for diagnosing coronary artery stenosis in patients with chest pain after PCI. Kappa test was used for comparison between DSCT and CAG in diagnosis consistency of coronary artery stenosis degree. Results The specificity,sensitivity,negative predictive value and positive predictive value of DSCT for diagnosing coronary artery stenosis were 85. 5%,96. 6%,94. 6%,90. 4%. DSCT and CAG were highly consistent in the diagnosis of coronary artery stenosis degree（ Kappa value= 0. 858）. The effective radiation dose of DSCT was 4. 67 ± 0. 87 m Sv. Conclusions DSCT coronary angiography is able to obtain high quality images in patients with chest pain after PCI. It is accurate to evaluate the degree of coronary artery stenosis,radiation dose is low,and it is worthy of clinical spread.