冠状动脉周围脂肪直方图参数鉴别急性冠状动脉综合征及稳定性冠心病的价值初探

Preliminary study on the value of pericoronary adipose tissue histogram parameters for the differentiation of acute coronary syndrome and stable coronary artery disease

目的探讨基于冠状动脉CT血管成像(CTA)图像的冠状动脉周围脂肪组织直方图参数在鉴别急性冠状动脉综合征及稳定性冠心病中的价值。方法回顾性分析2013年至2018年苏州九龙医院的93例行冠状动脉CTA检查患者的临床资料及CTA图像。其中39例为急性冠状动脉综合征患者(急性冠状动脉综合征组),54例为稳定性冠心病患者(稳定性冠心病组)。在狭窄冠脉周围勾画感兴趣区(ROI),取CT值范围为-190^-30 HU以剔除非脂肪组织。测量剔除非脂肪后的ROI的CT值,行直方图分析,所获参数包括平均值、中位数和第5百分位数、第10百分位数、第45百分位数、第55百分位数、第70百分位数、第95百分位数。比较两组之间的直方图参数的差异,随后基于受试者操作特征(ROC)曲线分析,评价各参数鉴别急性冠状动脉综合征和稳定性冠心病的价值,并用逐步后退式的多元逻辑回归分析进行特征筛选并构建最终的预测模型,绘制最终模型的ROC曲线并分析其价值。结果急性冠状动脉综合征组与稳定性冠心病组间平均值、中位数和第5、10、45、55、70、95百分位数差异有统计学意义(P均<0.05)。其中中位数和第95百分位数的ROC曲线下面积均为0.73。通过多元逻辑回归构建的诊断模型的灵敏度为82.1%,特异度为89.1%,曲线下面积为0.90。结论冠状动脉周围脂肪组织直方图分析在鉴别急性冠状动脉综合征和稳定性冠心病中具有较高价值。

Objective To investigate the value of pericoronary adipose tissue histogram parameters based on coronary CT angiography(CTA)images for the differentiation of acute coronary syndrome and stable coronary artery disease.Methods The clinical data and CTA images of 93 patients with coronary CTA examination in Suzhou Kowloon Hospital from 2013 to 2018 were analyzed retrospectively.There were 39 patients with acute coronary syndrome(acute coronary syndrome group)and 54 patients with stable coronary artery disease(stable coronary artery disease group).A region of interest(ROI)was drawn around the stenosis of the coronary arteries,with CT attenuation ranging from-190 to-30 HU to exclude non-adipose tissue.The CT attenuation of ROI excluding non-adipose were measured and histogram analysis was performed.The obtained parameters included the mean value,median value and the 5th,10th,45th,55th,70th and 95th percentiles.The differences in histogram parameters between the two groups were compared,and then the value of each parameter in differentiating acute coronary syndrome and stable coronary artery disease was evaluated based on receiver operating characteristic(ROC)analysis.The stepwise regression of multivariate logistic regression analysis was used to identify the useful features and establish the final prediction model.The ROC curve of the final model was calculated and its value was analyzed.Results The mean,median and the 5th,10th,45th,55th,70th and 95th percentile differences between the acute coronary syndrome group and the stable coronary artery disease group were statistically significant(all P<0.05).The ROC curve for the median and the 95th percentile had the same area under curve(AUC)of 0.73.The sensitivity,specificity and AUC of the diagnostic model established by multiple logistic regression were 82.1%,89.1%and 0.90 respectively.Conclusion CT attenuation histogram of pericoronary adipose tissue is of high value in differentiating acute coronary syndrome from stable coronary artery disease.