CCTA与DSA在诊断冠状动脉斑块的临床应用价值

Clinical application of coronary CT angiography and DSA in the diagnosis of coronary artery plaques

目的:探讨冠状动脉CT血管造影(CCTA)与数字减影血管造影(DSA)在诊断冠状动脉斑块中的应用价值。方法:回顾性选取2020年1月—2023年5月本院诊断为冠心病的患者64例,均行CCTA和DSA检查,以DSA为金标准,分析比较CCTA和DSA对冠状动脉斑块检出率及性质和狭窄程度的诊断价值。结果:64例患者经DSA检出冠状动脉斑块58例(90.63%),其中轻度狭窄21例,中度狭窄23例,重度狭窄14例,无法有效判断动脉斑块性质。经CCTA检出冠状动脉斑块55例(85.94%),其中轻度狭窄19例,中度狭窄22例,重度狭窄14例,12例非钙化斑块、13例混合斑块和30例钙化斑块。以DSA为金标准,CCTA诊断冠状动脉斑块的灵敏度为94.83%、特异度为83.33%、准确度为93.75%、阳性预测值为98.21%、阴性预测值为62.50%、Kappa系数值为0.680。CCTA和DSA在冠状动脉狭窄程度的检出率比较上均无差异(P>0.05)。轻度狭窄者钙化斑块发生率高于中度和重度狭窄者,非钙化、混合斑块发生率低于中度和重度者(P<0.05)。结论:CCTA与DSA在诊断冠状动脉斑块及其狭窄程度上具有高度一致性,但CCTA较DSA对斑块性质的诊断价值更高。

Objective:To explore the application value of coronary CT angiography(CCTA)and DSA in the diagnosis of coronary artery plaques.Methods:A total of 64 patients with coronary heart disease in the hospital were enrolled between January 2020 and May 2023.All the patients underwent CCTA and DSA.The detection rates of coronary artery plaques by CCTA and DSA were calculated.Taking DSA as the golden standard,the diagnostic values of CCTA in plaque property and stenosis degree were analyzed.Results:Among the 64 patients,there were 58 cases(90.63%)with coronary artery plaques in DSA,including 21 cases with mild stenosis,23 cases with moderate stenosis,and 14 cases with severe stenosis.There were 55 cases(85.94%)with coronary artery plaques in CCTA,including 19 cases with mild stenosis,22 cases with moderate stenosis,14 cases with severe stenosis,12 cases with non-calcification plaques,13 cases with mixed plaques,and 30 cases with calcification plaques.Taking DSA as the golden standard,sensitivity,specificity,accuracy,positive predictive value,negative predictive value and Kappa coefficient of CCTA in the diagnosis of coronary artery plaques were 94.83%,83.33%,93.75%,98.21%,62.50%and 0.680.There was no significant difference in the detection of coronary stenosis between CCTA and DSA(P>0.05).Calcification plaques in patients with mild stenosis was higher than that with moderate and severe stenosis,while non-calcification and mixed plaques was lower than that with moderate and severe stenosis(P<0.05).Conclusion:CCTA has high consistency with DSA in the diagnosis of coronary artery plaques and stenosis degree.Moreover,CCTA has a higher diagnostic value for plaque properties compared to DSA.