新型256层螺旋CT自由心率CCTA评价高心率冠状动脉狭窄患者诊断准确性

Evaluation of diagnostic accuracy of free-heart-rate CCTA using new type 256-row MDCT for patients with coronary artery stenosis and with high heart rate

目的:探讨新型256层螺旋CT自由心率下CCTA对高心率冠心病患者冠状动脉管腔狭窄程度的诊断准确性。方法:回顾性分析40例高心率(≥80bpm)冠心病患者,均采用自适应前瞻性心电门控且自由心率下扫描,均在CCTA检查3周内行冠状动脉造影(CGA)检查,且以CAG为金标准,计算其冠状动脉狭窄程度的敏感度、特异度、阳性预测值、阴性预测值及准确性,用Kappa检验对CCTA及CAG检测冠状动脉狭窄程度进行一致性分析。结果:40例患者共检出467个冠状动脉节段,其CCTA图像质量可诊断率达到98.93%,CAG与CCTA对诊断冠状动脉狭窄的一致性显著,kappa系数均>0.8;CCTA诊断冠状动脉狭窄节段的敏感度、特异度、阳性预测值、阴性预测值及准确度分别为96.80%、92.93%、90.30%、97.71%、94.50%,对中度狭窄、重度狭窄及闭塞的冠状动脉的诊断准确度分别为97.27%、99.03%、98.92%。结论:新型256层螺旋CT自由心率下CCTA对高心率冠心病患者冠状动脉管腔狭窄程度有较好的诊断准确性。

Objective：To investigate the diagnostic accuracy of free heart rate CCTA using new type 256-row MDCT for patients with coronary artery stenosis and with high heart rate.Methods：Data of 40 high heart rate（80 bmp）patients with coronary heart disease scanned with new type 256-MDCT with adaptive and prospective free-heart-rate gating were retrospectively analyzed.Using coronary angiography（CAG）as the gold standard,all participants have completed CAG in 3 weeks after CCTA examination.The sensitivity,specificity,positive predictive value,negative predictive value as well as accuracy of the degree of coronary artery stenosis were calculated,then Kappa test was applied for consistency analysis of narrowing of coronary artery between CCTA and CAG.Results：467 coronary arterial segments were identifed in the 40 patients,while the rate of CCTA image of diagnostic quality was 98.93%.CCTA has high consistency with CAG,with the kappa coefficient greater than0.8.Sensitivity,specificity,positive predictive value,negative predictive value as well as accuracy rate of CCTA detcting coronary artery stenosis segment were 96.80%、92.93%、90.30%、97.71%、94.50%,respectively.The diagnostic accuracy of severe stenosis and occlusion of coronary arteries were 99.03%and 98.92%.Conclusion：Free heart rates CCTA using the new type 256-MDCT has high diagnostic accuracy in evaluating coronary artery stenosis for high-heart-rate patients with coronary heart disease.