破裂和高危动脉粥样硬化斑块的冠状动脉CT血管造影特征与血管内超声的关系

Relationship between coronary CTA features and intravascular ultrasound in ruptured and high⁃risk atherosclerotic plaque

目的探讨破裂和高危动脉粥样硬化斑块的冠状动脉CT血管造影(CTA)特征与血管内超声(IVUS)的关系。方法回顾性以重庆三峡中心医院2017年3月至2019年3月行经皮冠状动脉介入治疗的稳定型心绞痛和急性冠状动脉综合征(ACS)病人各32例为研究对象。所有病人在冠状动脉介入治疗前行冠状动脉CTA、IVUS和虚拟组织学血管内超声(VH-IVUS)检查。比较VH-IVUS诊断的薄帽型纤维粥样硬化斑块(TCFA)中钙化斑块、低衰减斑块、正性重塑及餐巾环征等CTA高风险特征的关系。结果冠状动脉CTA正确诊断出破裂斑块26/39个,有3个斑块的诊断为假阳性,灵敏度为66%,特异度为91%。融合坏死核心斑块的低衰减斑块、餐巾环征、坏死核心体积、坏死核心/纤维斑块比值等CTA特征均显著升高(P<0.05)。TCFA的坏死核心体积、坏死核心/纤维斑块比值等CTA特征显著升高(P<0.05),纤维斑块体积显著降低(P<0.05)。坏死核心体积、坏死核心/纤维斑块比值等CTA特征在诊断纤维粥样硬化斑块的受试者工作特征曲线(ROC)下面积分别为0.730、0.872(P<0.05)。ACS病人中罪犯斑块的CTA高危特征检出率均显著升高(P<0.05)。结论与IVUS相比,冠状动脉CTA识别破裂斑块的特异度高,但灵敏度低。此外,低衰减斑块、餐巾环征、坏死核心体积、坏死核心/纤维斑块比值等CTA高风险特征能很好的识别VH-IVUS诊断的融合坏死核心的斑块及TCFA,尤其是在ACS病人中。

Objective To investigate the relationship between coronary CT imaging(CTA)and intravascular ultrasound(IVUS)in ruptured and high⁃risk atherosclerotic plaques.Methods Thirty⁃two patients with stable angina pectoris and 32 acute coronary syn⁃drome(ACS)who underwent percutaneous coronary intervention in Chongqing Three Gorges Central Hospital from March 2017 to March 2019 were enrolled in the retrospectively study.All patients underwent coronary CTA,IVUS,and virtual histological intravas⁃cular ultrasound(VH⁃IVUS)prior to coronary intervention.The relationship between high⁃risk characteristics of CTA such as calci⁃fied plaque,low⁃attenuation plaque,positive remodeling,and napkin ring sign in thin⁃cap fiber atherosclerotic plaque(TCFA)diag⁃nosed by VH⁃IVUS was compared.Results Coronary CTA correctly diagnosed 26/39 ruptured plaques,and 3 plaques were diag⁃nosed as false positives with a sensitivity of 66%and a specificity of 91%.The CTA features of low⁃attenuation plaque,napkin ring sign,necrotic core volume,necrotic core/fiber plaque ratio of plaque with necrotic core were significantly increased(P<0.05).The CTA characteristics of necrotic core volume,necrotic core/fiber plaque ratio of TCFA were significantly increased(P<0.05),and the volume of fibrous plaque was significantly decreased(P<0.05).The ROC curve of the CTA characteristics of the area of the necrotic core volume,necrotic core/fiber plaque ratio diagnostic atherosclerotic plaque were 0.730 and 0.872,respectively(P<0.05).The detection rate of CTA high⁃risk characteristics of culprit plaques in ACS patients was significantly increased(P<0.05).Conclusions Compared with intravascular ultrasound,coronary CTA recognizes ruptured plaques with high specificity but low sen⁃sitivity.In addition,high⁃risk CTA features such as low⁃attenuation plaque,napkin ring sign,necrotic core volume,and necrotic core/fiber plaque ratio can well identify plaques with necrotic core and TCFAs diagnosed by VH⁃IVUS,especially in ACS patients.