基于CT冠状动脉周围脂肪测量对冠状动脉非钙化斑块风险分层的价值初探

Risk stratification study of non-calcified coronary plaques based on CT pericoronary adipose tissue measurement

目的:探讨基于冠状动脉周围脂肪衰减指数(FAI)测量对不同狭窄程度及不同CT值的非钙化斑块进行风险分层的相关性研究。方法:回顾性分析269例临床拟诊冠心病患者的冠状动脉CT血管造影图像,根据管腔狭窄程度分为四组,包括正常组60例、轻度组104例、中度组63例和重度组42例(病变组冠状动脉均仅存在非钙化斑块)。测量病变组各支冠状动脉的非钙化斑块CT值,根据斑块CT衰减值分为三组,包括低衰减组21例(CT值≤30 HU)、中等衰减组84例(30<CT值≤50 HU)、高衰减组104例(50<CT值≤120 HU)。在数坤冠状动脉CT造影图像分析软件上提取所有纳入的冠状动脉近端0~40 mm处FAI值。分析不同狭窄程度、不同CT值的冠状动脉非钙化斑块与FAI值的差异及相关性。结果:冠状动脉正常组与病变组在性别、年龄上差异无统计学意义(P>0.05),FAI值差异具有统计学意义(P<0.05),病变组FAI值明显高于正常组。不同CT衰减值的非钙化斑块FAI值差异具有统计学意义(P<0.05),低衰减组与中高衰减组FAI差异明显(P<0.05),但中等衰减组与高衰减组FAI值无明显差异(P>0.05)。由非钙化斑块引起的管腔轻度、中度、重度狭窄与FAI值呈正相关(Rs=0.534,P<0.05),斑块CT衰减系数与FAI值呈负相关(Rs=-0.271,P<0.05)。不同狭窄程度的非钙化斑块FAI值差异具有统计学意义(P<0.05),轻度组与中、重度组FAI值差异明显(P<0.05),但中度组与重度组二者FAI值无明显差异(P>0.05)。结论:基于FAI值能对冠状动脉非钙化斑块进行功能学水平的风险分层评估,有望对冠心病严重程度及急性冠状动脉综合征的发生进行预测。

Objective:To preliminarily investigate the risk stratification correlation study of non-calcified plaques with different degrees of stenosis and different CT values based on the pericoronary fat attenuation index(FAI).Methods:The coronary CT angiography(CCTA)images of 269 patients with clinically suspected coronary artery disease were retrospectively analyzed and divided into four groups based on the degree of luminal stenosis,including control group of normal coronary arteries on CCTA(60 cases),mild group(104 cases),moderate group(63 cases)and severe group(42 cases)(all lesion groups had only non-calcified plaques and stenosis assessed by digital subtraction angiography).The CT values of non-calcified plaques in each branch of coronary arteries were measured in all lesion groups and divided into three groups according to the plaque CT values,including 21 cases in the low-attenuation group(CT value≤30HU),84 cases in the moderate-attenuation group(30<CT value≤50HU),and 104 cases in the high-attenuation group(50<CT value≤120HU).Using the Shukun CCTA image analysis software,FAI values at 0~40mm proximal to the coronary artery were extracted for all included cases.The correlation between coronary non-calcified plaques with different degrees of stenosis and different CT values and FAI was analyzed.Results:There was a positive correlation between different degrees of coronary stenosis and FAI values around non-calcified plaques(P<0.05),while there was a negative correlation between FAI values around plaques and plaque CT values(P<0.05).The difference in FAI around different plaque CT values was statistically significant(P<0.05),and there was a significant difference in FAI between the low attenuation group and both medium and high attenuation groups(P<0.05),while the difference in FAI between the medium and high attenuation groups was not significant(P>0.05).There was a statistically significant difference in FAI between different degrees of stenosis(P<0.05),and a significant difference in FAI between mild and moderate-severe stenosis(P<0.05),while there was little difference in FAI between moderate and severe stenosis(P>0.05).Conclusion:Risk stratification assessment of non-calcified plaques with different stenosis degrees and different plaque CT values in coronary arteries based on FAI can have potential predictive value for coronary artery disease extent estimation.