Revolution CT在冠状动脉易损斑块诊断的预测价值

The predictive value of Revolution CT in vulnerable coronary plaque

目的探讨Revolution CT在冠状动脉易损斑块诊断的预测价值和作用。方法选取上海健康医学院附属周浦医院2018年1月~2019年7月间怀疑急性冠状动脉综合征的58例同时行Revolution CT检查及血管内超声检查的患者,男性28例,女性30例,年龄48~86岁,平均年龄(69.3±9.2)岁,检查Revolution CT在斑块定量检测与血管内超声的一致性,定量指标包括管腔直径狭窄率、面积狭窄率、血管外膜横截面积(EEM-CSA)、最小管腔面积(MLA)、最小管腔直径(MLD)、斑块面积(PA)、斑块负荷(PB)及血管重构指数(RI),以及计算Revolution CTA诊断易损斑块的敏感性、特异性、阳性预测值、阴性预测值。结果以血管内超声为金标准,Revolution CT对临界病变的管腔直径狭窄率、面积狭窄率、MLA、MLD、EEM-CSA、PA、PB及RI测量结果差异无明显统计学意义(t值分别为1.468、1.761、1.086、1.909、1.214、0.829、0.264、1.383,P值均>0.05),且相关性较好(r值分别为0.634、0.732、0.719、0.813、0.732、0.69、0.658、0.732);Revolution CT诊断易损斑块的敏感性、特异性、阳性预测值、阴性预测值及准确性分别为73.81%、70.27%、73.17%、68.42%及70.89%。结论Revolution CT和血管内超声对于斑块的定量有良好的一致性,对于冠状动脉易损斑块具有良好的预测率。

Objective To evaluate the predictive value and role of Revolution CT in the diagnosis of vulnerable coronary plaque.Methods 58 patients suspected of acute coronary syndrome who underwent Revolution CT and intravascular ultrasound from January 2018 to July 2019 in the Affiliated Zhoupu Hospital of Shanghai University of Medicine&Health Sciences were enrolled.Among them,28 were male and 30 were female.The average age was(69.32±9.16)years.The consistency between Revolution CT and intravascular ultrasound in plaque quantitative detection,including lumen diameter stenosis rate,area stenosis rate,external elastic membrane cross-sectional area(EEM-CSA),minimum lumen area(MLA),minimum lumen diameter(MLD),plaque area(PA),plaque burden(PB)and remolding index(RI),was checked,and the sensitivity,specificity,positive predictive value and negative predictive value of Revolution CT in the diagnosis of vulnerable plaque were calculated.Results With intravascular ultrasound as the gold standard,Revolution CT had no significant difference in the critical lesion plaque measurement results of lumen diameter stenosis rate,area stenosis rate,MLA,MLD,EEM-CSA,PA,PB and RI of critical lesions(t value was 1.468,1.761,1.086,1.909,1.214,0.829,0.264,1.383,P value>0.05,and R value was 0.634,0.732,0.719,0.813,0.732,0.69,0.658,0.732 respectively);The sensitivity,specificity,positive predictive value,negative predictive value and accuracy of Revolution CT in diagnosing vulnerable plaque were 73.81%,70.27%,73.17%,68.42%and 70.89%,respectively.Conclusion There is a good consistency between Revolution CT and intravascular ultrasound in plaque quantitative detection.Revolution CT has a good prediction rate for vulnerable coronary plaque.