基于双源CT与冠状动脉造影对冠状动脉狭窄诊断的对比研究

Comparative study of dual-source CT coronary angiography and conventional coronary angiography in the diagnosis of coronary stenosis

目的观察双源CT冠状动脉血管成像(DSCT-CA)对于冠状动脉狭窄的诊断意义。方法选取278例冠状动脉粥样硬化性心脏病(CHD)患者首先进行DSCT-CA检查,30 d之内进行CAG检查,以冠状动脉造影(CAG)结果为金标准。以冠脉狭窄50%和75%为界,基于患者、冠脉血管和冠脉血管节段分别计算DSCT-CA定量评估冠脉狭窄的敏感性、特异性、阳性预测值、阴性预测值及准确性。对2种方法的诊断结果进行一致性检验(Kappa检验)。结果分别以CAG冠脉狭窄50%和75%为界值分析DSCT-CA定量评估冠脉狭窄的价值。基于患者,DSCT-CA诊断的敏感性为99.6%、99.1%,特异性为84.2%、89.6%,准确性为98.6%、97.5%,Kappa值为0.88、0.91。基于冠脉血管,DSCT-CA诊断的敏感性为92.0%、96.9%,特异性为89.9%、94.8%,准确性为91.0%、95.8%,Kappa值为0.88、0.92。基于冠脉血管节段,DSCT-CA诊断的敏感性为97.3%、96.5%,特异性为93.3%、98.1%,准确性为94.2%、97.9%,Kappa值为0.84、0.91。结论在基于患者、冠脉血管的分析中,DSCT-CA可较准确地评估不同程度的冠脉狭窄,但在基于冠脉血管节段的分析中,DSCT-CA的诊断可能出现假阳性结果,故目前DSCT-CA可取代部分CAG,尚不能完全取代CAG。

Objective To determine the diagnostic accuracy of dual- source computed tomography coronary angiography （DSCT-CA） for detecting various degrees of coronary artery stenosis. Methods A total of 278 patients with coronary atherosclerotic heart disease （CHD） were selected for DSCT-CA examination. The coronary angiography （CAG） examination was carried out within 30 days in these patients. The result of CAG was used as the gold standard. The coronary artery stenosis of 50% and 75% was used as the sector. Based on the data of patients, DSCT-CA was calculated for quantitative assessment of the sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of coronary stenosis for the coronary blood vessels and coronary artery segments. Kappa consistence test was used to analyze the results of two methods. Results The 50%and 75%of coronary artery stenosis was used for the sector, based on the patients, the sensitivities of DSCT-CA were 99.6% and 99.1%, specificities were 84.2%, 89.6%, diagnostic accuracies were 98.6%and 97.5%, and the Kappa values were 0.88 and 0.91. Based on coronary vessels, the sensitivities were 92.0%and 96.9%, specificities were 89.9%and 94.8%, diagnostic accuracies were 91.0%and 95.8%, and the Kappa values were 0.88 and 0.92. Based on coronary artery segments, the sensitivities were 97.3%, 96.5%, specificities were 93.3%, 98.1%, diagnostic accuracies were 94.2%and 97.9%, and the Kappa values were 0.84 and 0.91. Conclusion Based on patient’s coronary artery analysis, DSCT-CA can accurately assess the different degrees of coronary stenosis, but based on the analysis of the coronary artery segment, the false-positive results may occur in the diagnosis of DACT-CA, which suggests that DSCT-CA can partly replace the CAG, still cannot completely replace the CAG.suggests that DSCT-CA can partly replace the CAG, still cannot completely replace the CAG.