双源CTA对冠状动脉临界狭窄病变斑块判断的价值

发布时间：2018-03-10 07:10

本文选题：冠状动脉临界病变　切入点：双源螺旋CT　出处：《中国医学计算机成像杂志》2017年03期 　论文类型：期刊论文

【摘要】：目的:以血管内超声(IVUS)为金标准,判断双源螺旋CT冠状动脉CT血管造影(DSCTA)对临界病变的斑块定量及斑块稳定性评估的价值。方法:回顾性分析经冠状动脉造影(CAG)证实的临界病变62例(83个部位),男性25人,女性37人,均于来院后先行DSCTA后1~2周内做CAG及IVUS检查。在DSCTA和IVUS图像上分别测量临界病变血管外膜内面积(EEMCSA)、最小管腔面积(MLA)、斑块面积(PA)、斑块负荷(PB)、面积狭窄率及血管重构指数(RI),并进行相关性分析;进一步以IVUS为金标准,判断DSCTA诊断易损斑块的敏感性、特异性、阳性预测值、阴性预测值及准确性。结果:以IVUS为金标准,DSCTA对冠脉临界病变的管腔狭窄率判断无明显统计学差异,EEMCSA、MLA、PA、PB及RI测量结果无明显差异,且相关性好,但DSCTA对EEMCSA、MLA、PA、PB及RI指标均有低估倾向。83个临界病变中,DSCTA诊断易损斑块的敏感性、特异性、阳性预测值、阴性预测值及准确性分别为72.92%、74.29%、79.55%、66.67%及73.49%。结论:以IVUS为金标准,DSCTA可以对冠脉临界性病变进行较准确的定量和定性诊断。
[Abstract]:Objective: to use intravascular ultrasound (IVUS) as the gold standard. To evaluate the value of dual-source spiral CT coronary angiography (DSCTAs) in evaluating the plaque quantity and plaque stability in patients with critical lesions. Methods: 62 cases (83 sites, 25 males) with critical lesions confirmed by coronary angiography (CAG) were retrospectively analyzed. 37 women, CAG and IVUS were performed within 1 and 2 weeks after admission to hospital. The CAG and IVUS were measured on the DSCTA and IVUS images respectively. The minimum lumen area (MLAA), plaque area (PAA), plaque load, area stenosis rate and vascular remodeling finger were measured on DSCTA and IVUS images, respectively. The correlation analysis was carried out. Furthermore, the sensitivity, specificity and positive predictive value of DSCTA in the diagnosis of vulnerable plaque were determined by IVUS as the gold standard. Results: there was no significant difference between IVUS and RI in judging the stenosis rate of critical coronary artery lesions. There was no significant difference in the results of EEMCSAA MLAA PAPB and RI, and the correlation was good. The sensitivity, specificity and positive predictive value of DSCTA in the diagnosis of vulnerable plaques in 83 critical lesions were significantly lower than those in the control group, but there was a tendency to underestimate the indexes of PAPB and RI in EEMCSAN MLAA. The negative predictive value and accuracy were 72.92% and 79.55%, respectively. Conclusion: using IVUS as the gold standard, DSCTA can be used for accurate quantitative and qualitative diagnosis of coronary critical lesions.
【作者单位】：上海交通大学医学院附属仁济医院放射科;上海市浦东新区周浦医院放射科;
【分类号】：R543.3;R816.2

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