能谱CT去除冠状动脉钙化性斑块硬化伪影对心血管狭窄程度的诊断价值

Diagnostic value of spectral CT for removal plaque sclerosis artifact of coronary artery calcification in cardiovascular stenosis

目的研究能谱CT去除冠状动脉钙化性斑块硬化伪影在心血管狭窄程度评估中应用价值。方法选择2016年1月至2017年7月新疆兵团第一师医院临床怀疑或诊断为冠心病(CHD)的患者50例,其中男性26例,女性24例;年龄37~83岁,平均年龄62.36岁。分别进行冠状动脉造影(CAG)检查及能谱CT检查,以CAG检查结果作"金标准",统计分析能谱CT不同keV值(70~140 keV)准确度,并将50例患者依据检查方式分为能谱图像-仿真血管内超声(VIVUS组)、能谱图像组、120 kVp组及120 kVp-V-IVUS组,对比不同诊断方式诊断情况及诊断符合率。结果经CAG筛查共选取141节段心血管可进行评估,能谱CT 120 keV准确度(95.04%)较130 keV(92.91%)、140 keV(91.49%)高,但差异无统计学意义(P>0.05);120 kVp诊断符合率(90.07%)及120 kVp-V-IVUS诊断符合率(90.78%)较CAG低,差异有统计学意义(P<0.05);能谱图像诊断符合率(96.45%)、能谱图像-V-IVUS诊断符合率(97.87%)与CAG比较,差异无统计学意义(P>0.05),且能谱图像-V-IVUS诊断符合率较能谱图像略高,但差异无统计学意义(P>0.05)。结论能谱CT在冠状动脉血管狭窄程度评估中具有较高准确度,且120 keV能谱CT去除冠状动脉钙化性斑块硬化伪影诊断效果更好,可为临床全面评估CHD病情及制定治疗方案提供一定参考依据。

Objective To study the diagnostic value of spectral CT for removal plaque sclerosis artifact of coronary artery calcification in arterial stenosis. Methods From January 2016 to July 2017, a total of 50 suspected or diagnosed coronary artery disease（CHD） patients were enrolled, which included 26 males and 24 females, aged 37-83 years old with mean age of 62.36 years old. All of them were performed by coronary angiography（CAG） and CT. The CAG result was set as ＂golden standard＂.The accuracy of spectral CT different values（70-140 keV） were analyzed. The 50 patients were divided into 4 groups, which was spectral image-V-IVUS group, spectral image group, 120 kVp group and 120 kVp-V-IVUS group by examination method, then the diagnostic situation and coincidence rate of different diagnostic methods were compared. Results A total of141 segments of blood vessels by CAG screening were evaluated. The accuracy in spectral CT 120 keV group was 92.91 %,which was higher than those in 130 keV group（92.91 %） and 140 keV group（91.49 %）, but the difference was no statistically significant（P〈0.05）. The diagnostic coincidence rate in 120 kVp group（90.07 %） and 120 kVp-V-IVUS group（90.78 %）were lower than that of CAG, and the difference was statistically significant（P〈0.05）. The diagnostic coincidence rate was no statistically significant between CAG and spectral image group（96.45 %）, spectral image-V-IVUS group（97.87 %）（P〈0.05）.The diagnostic coincidence rate in spectral image-V-IVUS group was slightly higher than that in spectral image group, but the difference was no statistically significant（P〉0.05）. Conclusion It is demonstrated that the spectral CT showed the higher accuracy in assessing coronary artery stenosis, and removal of diagnosis effect in coronary calcification plaque sclerosis artifact by 120 keV spectrum CT is better, which could provide the certain reference for clinical comprehensive assessment of coronary heart disease and the development of treatment options.