冠状动脉CTA腔内密度校正差诊断冠状动脉支架内再狭窄的应用价值

Application value of difference of corrected coronary opacification of coronary in the diagnosis of coronary artery In-stent restenosis restenosis.

目的探讨冠状动脉电子计算机断层扫血管成像(CTA)腔内密度校正差(DCCO)诊断冠状动脉支架内再狭窄(ISR)的临床价值。方法回顾性选取2021年1月至2024年2月在新疆医科大学第一附属医院接受冠状动脉支架植入治疗的患者86例作为研究对象。均为术后出现疑似复发的冠状动脉疾病或支架内再狭窄症状,并在1个月内接受CTA与有创冠状动脉造影(ICA)检测。比较ISR与血管开放的DCCO值以及不同方法诊断ISR的结果。结果ICA检查结果显示,152支血管中通畅89支,ISR 63支;CTA检测为通畅82支,ISR 70支。CTA与ICA对ISR诊断的Kappa值为0.613,一致性一般。ISR组血管的DCCO值相比通畅组血管明显升高,差异有统计学意义(P<0.05)。DCCO结合CTA检测为通畅87支,ISR 75支。DCCO结合CTA与ICA对ISR诊断的Kappa值为0.838,一致性较高。DCCO结合CTA诊断ISR的敏感度、特异度、阳性预测值、阴性预测值、诊断符合率分别为92.06%、92.13%、89.39%、95.35%、92.76%,均明显高于单纯CTA(82.54%、79.78%、74.29%、86.59%、80.92%),差异均有统计学意义(P<0.05)。结论冠状动脉CTA腔内密度校正差,能够在一定水平上提升对ISR的检测精确度,可作为评价动脉狭窄程度的定量指标参数,具有较高的临床应用价值。

Objective To investigate the clinical value of difference of corrected coronary opacification(DCCO)of coronary computed tomography angiography(CTA)in the diagnosis of coronary artery in-stent restenosis(ISR).Methods A total of 86 patients who underwent coronary stent implantation in the First Affiliated Hospital of Xinjiang Medical University from January 2021 to February 2024 were retrospectively selected as the study subjects.All patients had suspected recurrent coronary artery disease or in-stent restenosis after operation,and received CTA and invasive coronary angiography(ICA)within 1 month.The DCCO values of ISR and vascular opening and the results of different methods for diagnosing ISR were compared.Results Among the results of ICA examination,89 vessels of 152 vessels were patency and 63 ISR vessels were patency.There were 82 CTA and 70 ISR detections.The Kappa value of CTA and ICA for ISR diagnosis was 0.613,with general consistency.The DCCO value of blood vessels in ISR group was significantly higher than that in patency group,and the difference was statistically significant(P<0.05).DCCO combined with CTA detected 87 unblocked cells and 75 ISR cells.The Kappa value of DCCO combined with CTA and ICA for ISR diagnosis was 0.838,with high consistency.The sensitivity,specificity,positive predictive value,negative predictive value and diagnostic coincidence rate of DCCO combined with CTA in the diagnosis of ISR were 92.06%,92.13%,89.39%,95.35%and 92.76%,respectively,which were significantly higher than those of CTA alone(82.54%,79.78%,74.29%,86.59%,80.92%),and the differences were statistically significant(P<0.05).Conclusion The poor correction of intracavity density of coronary artery CTA can improve the detection accuracy of ISR to a certain extent,and can be used as a quantitative index parameter to evaluate the degree of arterial stenosis,which has high clinical application value.