冠状动脉CT血管造影评估冠状动脉慢性完全性闭塞

Coronary CT angiography for evaluating cornary chronic total occlusion

目的观察冠状动脉CT血管造影(CCTA)评估冠状动脉慢性完全闭塞(CTO)的可靠性。方法回顾性分析201例经有创冠状动脉造影(ICA)确诊的CTO患者共207处病变的CCTA资料,观察CCTA与ICA显示CTO特征的一致性、差异及符合率,包括冠状动脉闭塞段头端形态(钝形/锥形),闭塞段内有无钙化、纡曲、近端分支及闭塞段长度是否≥20 mm。结果CCTA与ICA检出冠状动脉闭塞段头端钝形(Kappa=0.50)、闭塞段内有无钙化(Kappa=0.48)、闭塞段近端有无分支(Kappa=0.56)及病变长度≥20 mm(Kappa=0.53)与否的结果具有中度一致性(P均<0.01),二者判断闭塞段是否纡曲的一致性好(Kappa=0.80,P<0.01)。CTA与ICA对冠状动脉闭塞段钙化[38.65%(80/207)vs.21.74%(45/207)]及闭塞近端分支[31.40%(65/207)vs.43.48%(90/207)]的检出率差异有统计学意义(P均<0.01),对闭塞段头端钝形[35.75%(74/207)vs.36.71%(76/207)]、闭塞段纡曲[20.29%(42/207)vs.23.19%(48/207)]及病变长度≥20 mm[38.65%(80/207)vs.41.06%(85/207)]的检出率差异均无统计学意义(P均>0.05)。CCTA与ICA检出冠状动脉闭塞段头端钝形、钙化、纡曲、近端存在分支及长度≥20 mm的符合率分别为76.81%(159/207)、77.29%(160/207)、93.24%(193/207)、79.23%(164/207)及77.29%(160/207)。结论利用CCTA能可靠评估CTO病变特征。

Objective To explore the reliability of coronary CT angiography(CCTA)for evaluating coronary chronic total occlusion(CTO).Methods CCTA data of 201 patients with 207 CTO lesions diagnosed with invasive coronary angiography(ICA)were retrospectively analyzed.The consistency,difference and coincidence rate of CCTA and ICA in evaluating characteristics of CTO lesions were observed,including the morphology of occlusion segment head(blunt/tapered),with/without calcification,bending,proximal branches in occlusive segment,and whether the length of lesion≥20 mm.Results There were moderate consistencies between CCTA and ICA in evaluating the occlusion segment head blunt(Kappa=0.50),with/without calcification(Kappa=0.48),proximal branches(Kappa=0.56)in occlusive segment and lesion length≥20 mm(Kappa=0.53,all P<0.01),while there was a excellent consistency in evaluating the occlusive segment bending(Kappa=0.80,P<0.01).There were significant differences between CCTA and ICA detection rates of calcification(38.65%[80/207]vs.21.74%[45/207])and proximal branches(31.40%[65/207]vs.43.48%[90/207],both P<0.01)in occlusive segments,while there was no significant difference of detection rates of occlusion segment head blunt(35.75%[74/207]vs.36.71%[76/207]),bending(20.29%[42/207]vs.23.19%[48/207])nor lesion length≥20 mm(38.65%[80/207]vs.41.06%[85/207],all P>0.05).The coincidence rate of CCTA and ICA in detecting blunt head,calcification,bending,proximal branch and length≥20 mm was 76.81%(159/207),77.29%(160/207),93.24%(193/207),79.23%(164/207)and 77.29%(160/207),respectively.Conclusion Using CCTA could reliably evaluating characteristics of CTO lesions.