冠状动脉CT血管造影与经胸超声心动图对川崎病并冠状动脉病变的诊断效能对比

Comparison of diagnostic efficacy of coronary CT angiography and transthoracic echocardiography in Kawasaki disease with coronary artery lesions

目的:探讨冠状动脉CT血管造影(CCTA)与经胸超声心动图(TTE)对川崎病(KD)并冠状动脉病变的诊断价值。方法:回顾性分析2019年1月至2022年12月我院收治的38例KD患儿的CCTA和TTE影像学资料,主要包括分析左、右冠状动脉主干、前降支及回旋支病变显示情况,包括病变的数目、位置、大小。以经皮冠状动脉造影(CAG)结果为金标准,分别计算2种检查方法诊断敏感度、特异性、阳性预测值、阴性预测值及准确率,并对CCTA及TTE诊断KD并冠状动脉病变结果的一致性行Kappa检验;采用受试者工作特征(ROC)曲线分析2种检查方法对KD并冠状动脉病变的诊断效能。结果:38例KD患儿中,经CAG证实,29例患儿冠状动脉异常,共检出病变冠状动脉96支;CCTA检出94支病变冠状动脉,检出率为97.92%(94/96),TTE检出83支病变冠状动脉,检出率为86.46%(83/96)。CCTA诊断KD冠状动脉病变的敏感度、特异性、阳性预测值、阴性预测值和准确率均高于TTE(P<0.05);CCTA与TTE诊断KD冠状动脉病变结果与CAG诊断结果一致性分别为较好和中等(Kappa=0.860、0.526);ROC曲线分析结果显示,CCTA与TTE诊断KD并冠状动脉病变的曲线下面积分别为0.933和0.679,差异有统计学意义(P<0.05)。结论:宽体探测器CT能够清晰显示冠状动脉全貌,诊断效能高于TTE,特别是对KD并冠状动脉中、远段病变诊断价值更高,能够弥补TTE检查不足,进一步提高诊断KD并冠状动脉病变的准确率,可作为临床补充检查手段。

Objective:To investigate the diagnostic value of coronary CT angiography(CCTA)and transthoracic echocardiography(TTE)in Kawasaki disease(KD)with coronary artery lesions.Methods:CCTA and TTE imaging data was retrospectively analyzed in 38 children with KD admitted to our hospital from Jan 2019 to Dec 2022,including analysis of the number,location and size of lesions in the the left and right main coronary artery,anterior descending branch and circumflex branch.Using percutaneous coronary angiography(CAG)results as the gold standard,the diagnostic sensitivity,specificity,positive predictive value,negative predictive value and accuracy of the two methods were compared,and the Kappa test was performed for the consistency of CCTA and TTE results in diagnosing KD with coronary artery lesions.Receiver operating characteristic(ROC)curve was used to analyze the diagnostic efficacy of the two methods for KD with coronary artery lesions.Results:Among 38 children with KD,coronary artery anomalies were confirmed by CAG in 29 children,with a total of 96 diseased coronary arteries.CCTA detected 94 diseased coronary arteries,with a detection rate of 97.92%(94/96),and TTE detected 83 diseased coronary arteries,with a detection rate of 86.46%(83/96).The sensitivity,specificity,positive predictive value and negative predictive value of CCTA in the diagnosis of coronary artery lesions in KD were higher than those of TTE(P<0.05).The consistence of CCTA and TTE in the diagnosis of KD with coronary artery lesions with CAG was good and moderate,respectively(Kappa=0.860 and 0.526).The results of ROC curve showed that the area under the curve(AUC)of CCTA and TTE in the diagnosis of KD with coronary artery lesions were 0.933 and 0.679,respectively,and the difference was statistically significant(P<0.05).Conclusion:Wide-body detector CT can clearly display the whole coronary artery,and its diagnostic efficacy is higher than that of TTE,especially for the diagnosis of KD with middle and distal coronary artery lesions,which can make up for the shortcomings of TTE,further improve the accuracy of diagnosing KD with coronary artery lesions,and can be used as a supplementary clinical examination.