128层螺旋CT评估冠状动脉狭窄的准确性-与传统冠状动脉造影的对照研究

The Accuracy of 128 Slice Spiral CT in Evaluation of Coronary Artery Stenosis: A Comparative Study with Conventional Coronary Angiography

目的对比分析冠状动脉成像CTA与常规冠脉造影CAG,探讨128层螺旋CT冠脉成像技术在冠心病诊断中的价值。方法对我院心血管科就诊患者进行随机选择582例,均进行128-MSCTA和CAG检查,得到1108处狭窄动脉节段,按狭窄程度将冠脉狭窄分成0级、1级、2级、3级和4级,分析128-MSCTA与CAG对各级别冠脉狭窄诊断的一致性,评价128层CT成像诊断冠心病的准确性及钙化与非钙化斑块对冠脉狭窄的影响情况。结果两组诊断0级、1级、2级、3级和4级冠脉狭窄的一致性佳(Kappa>0.75),冠脉狭窄0级、4级的敏感性、特异性、阳性预测值和阴性预测值高,分别为0级98.01%、98.15%、96.81%、98.86%;4级97.67%、98.72%、93.33%、99.57%。冠脉狭窄中1、2级敏感性为84.78%、87.31%,3级阳性预测值85.98%。冠脉钙化斑块与非钙化斑块在0、1、3、4级冠脉狭窄中差别有显著性意义(P<0.05)。结论 128层螺旋CT冠脉成像技术在诊断冠心病方面具有较高的准确性,可和常规冠脉造影媲美,但在128-MSCTA评估冠脉狭窄时,对轻度狭窄的诊断方面及重度狭窄程度评估方面可能产性偏差,应引起临床医师重视。

Objective To investigate the value of 128 slice spiral CT coronary angiography in the diagnosis of coronary artery disease by comparing CTA with conventional coronary angiography. Methods The cardiovascular clinic patients in our hospital were randomly selected 582, 128-MSCTA and coronary angiography （CAG） were performed to, 1108 artery stenosis segment, according to the degree of stenosis of coronary artery, is divided into grade 0, grade 1, grade 2,grade 3 and grade 4. To analyze the consistency of 128-MSCTA and GAG in the diagnosis of coronary artery stenosis and evaluate the accuracy of 128 slice CT imaging in diagnosis of coronary artery disease and the influence of calcification and non calcified plaque on the coronary artery stenosis. Results Group two diagnosis grade 0, grade 1, grade 2, grade 3 and grade 4 coronary stenosis good consistency （Kappa〈0.75）. coronary artery stenosis grade 0, 4 grade of sensitivity, specificity, positive predictive value and negative predictive value high, grade 0,98.01%, 98.15%, 96.81, 98.86%, grade 4, 97.67%, 98.72%, 93.33%, 99.57%. The sensitivity of grade 1 and grade 2 in coronary artery stenosis was 84.78%, 87.31% and grade 3, the positive predictive value was 85.98%. Calcified plaque and non calcified plaque in grade 0, 1, 3, 4 of coronary artery stenosis showed significant difference （P〈0.05）. Conclusion 128 slice spiral CT coronary angiography in the diagnosis of coronary heart disease with high accuracy, and conventional coronary angiography is comparable to, but in the 128-MSCTA assessment in coronary artery stenosis, mild stenosis diagnosis and severe degree of stenosis assessed possible bias, should cause clinician attention.