冠脉CTA与血管内超声对冠脉临界病变血管狭窄程度诊断价值对比研究

The Value of Computed Tomography Angiography in Diagnosis of Lumen Stenosis of Intermediate Coronary Lesions: Compared with Intravascular Ultrasound

目的:探讨冠脉CTA对冠脉临界病变管腔狭窄程度的诊断价值。方法:对2670例患者行DSCTA检查,其中158例在两周内行CAG检查,41例判定为冠脉临界病变行IVUS检查,配对比较DSCTA和IVUS两种检查方法所得冠脉狭窄的结果有无差异。以IVUS测量结果为标准,比较DSCTA诊断冠脉临界病变的价值。结果:入组33例患者,其中男性14例,女性19例,平均年龄65.8岁,涉及冠脉41个节段。比较DSCTA和IVUS测量冠脉狭窄指标MLA和PB的结果,两种检查方法无统计学差异(P>0.05)。以IVUS为金标准,MLA以4 mm^2为临界值,得出DSCTA诊断冠脉MLA的敏感性为69.2%,特异性为92.9%,阳性预测值为81.8%,阴性预测值为86.7%。结论:DSCTA作为一种无创性冠状动脉成像方法,简便经济,能较准确地判断冠脉临界病变,减少不必要的CAG和IVUS检查。

Objective： To explore the value of dual source computed tomography angiography in the diagnosis lumen stenosis of intermediate coronary lesions. Methods： DSCTA were performed in 2670 patients, among which 158 patients underwent both DSCTA and CAG within two weeks. And 41 cases were judged to be intermediate coronary lesions via IVUS. The results of DSCTA were compared with that of IVUS. Results： 41 segments of coronary artery in 33 patients （14 males, 19 females, mean age 65.8 years） were analyzed. There were no statistical differences （P 〉 0.05） compared with the result of Minimal Lumen Area （MLA） and Plaque Burden （PB） obtained by two methods. Regarding IVUS as the gold standard and MLA for 4mm2 as the critical value, the sensitivity, specificity, PPV and NPV of DSCTA were 69.2%, 92.9%, 81.8%, 86.7%, respectively. Conclusions：DSCTA, as a noninvasive and economic coronary artery examination, can accurately assess the degree of luminal stenosis, higher value to the diagnosis of non-pathological coronary stenosis, reducing unnecessary CAG and IVUS examination.