探讨双源CT双能量扫描对PCI术后支架内再狭窄的诊断价值

发布时间：2018-05-16 13:26

本文选题：双能量 + 双源CT　；参考：《兰州大学》2017年硕士论文

【摘要】：目的:评价双源CT双能量扫描肉眼定性、nIC定量及肉眼定性结合nIC定量三种方法分别对支架腔内再狭窄的诊断准确性。方法:使用西门子第二代双源CT扫描机对2015年11月~2016年12月于兰州大学第一医院行冠状动脉支架植入术后复诊的88例冠心病患者进行双能量扫描,最终纳入86名受试者,共152枚支架,其中男70名,女16名,年龄40-76岁,平均60.84±9.43岁。首先,采用5分半定量法对图像质量进行评估,并通过Spearman等级相关分析其影响因素;其次,以选择性冠状动脉造影结果为金标准,分别计算出肉眼定性分析、nIC定量分析及两者结合诊断冠状动脉支架内再狭窄的敏感度、特异度、阳性似然比、阴性似然比、阳性预测值、阴性预测值及诊断准确度,同时运用x2检验分别比较上述三种方法与金标准间差异;最后,采用x2检验比较肉眼定性分析、nIC定量分析及两者结合诊断冠状动脉支架再狭窄的各项准确性指标之间有无区别;所有统计学分析均通过SPSS Statistics version 21.0及MedCalc软件进行处理,P0.05为差异有统计学意义。结果:1.扫描所得86幅冠状动脉CT血管造影的图像质量评分范围为1~4分,平均1.86±0.78分。2.在金标准评定的152枚支架中,未见狭窄支架75枚,占49.34%;轻微狭窄支架29枚,占19.08%;轻度狭窄支架17枚,占11.18%;中度狭窄支架7枚,占4.60%;重度狭窄支架13枚,占8.55%;完全闭塞支架11枚,占7.24%。其中,属显著性狭窄(狭窄程度≥50%)支架共31枚,占20.39%。3.肉眼定性分析共检出未见狭窄支架103枚(67.76%)、轻微狭窄支架13枚(8.55%)、轻度狭窄支架11枚(7.24%)、中度狭窄支架3枚(1.97%)、重度狭窄支架13枚(8.55%)、闭塞支架9枚(5.92%);其中,属显著狭窄支架25枚,占16.45%。诊断冠状动脉支架腔内显著性狭窄的敏感度、特异度、阳性似然比、阴性似然比、阳性预测值、阴性预测值及诊断准确度分别为67.74%、96.69%、20.49、0.33、84%、92.13%、90.79%,与选择性冠状动脉造影所得结果的差异无统计学意义;4.nIC定量分析检出显著性狭窄支架27枚(17.76%),无显著性狭窄支架125枚(82.24%)。诊断冠状动脉支架腔内显著性狭窄的敏感度、特异度、阳性似然比、阴性似然比、阳性预测值、阴性预测值及诊断准确度分别为58.06%、92.56%、7.81、0.45、66.67%、89.60%、85.53%,与选择性冠状动脉造影所得结果的差异无统计学意义;5.肉眼定性结合nIC定量分析共检出显著性狭窄支架35枚(23.03%),无显著性狭窄支架117枚(76.97%)。诊断冠状动脉支架腔内显著性狭窄的敏感度、特异度、阳性似然比、阴性似然比、阳性预测值、阴性预测值及诊断准确度分别为83.87%、92.56%、11.28、0.17、74.29%、95.73%、90.79,与选择性冠状动脉造影所得结果的差异不具有统计学意义;6.肉眼定性分析、nIC定量分析及两者结合评价冠脉支架术后支架腔内显著性狭窄的各项准确性指标之间的差异均不具有统计学意义。结论:1.双源CT双能量扫描所得图像能将支架的植入位置以及管腔内的充盈程度明显清楚的展示出来,并能够较准确的对支架再狭窄进行分度、分级,明确再狭窄的原因及累及范围;2.双源CT双能量扫描可得到清晰的碘分布图,通过测量支架内碘含量,较大程度的提高了其诊断支架再狭窄的敏感度,但因其高假阳性导致特异度有所下降;3.双源CT双能量扫描初步实现了CT对支架再狭窄的定量分析,并为支架腔内斑块性质分析以及心肌缺血判断的定量分析奠定了坚实的基础。
[Abstract]:Objective: To evaluate the accuracy of the diagnosis of stent restenosis by three methods: double source CT double energy scanning naked eye, nIC quantitative and naked eye qualitative combination with nIC quantitative method. Method: 88 cases in December November 2015, First Hospital Affiliated to Lanzhou University after coronary stent implantation were reviewed with SIEMENS second generation double source CT scanner. The patients with coronary heart disease were scanned with double energy and were finally included in 86 subjects, with a total of 152 stents, including 70 men, 16 women, 40-76 years old and an average of 60.84 9.43 years. First, the quality of the images was evaluated by the method of 5 and half quantitation, and the influence factors were analyzed by Spearman level correlation; secondly, selective coronary arteriography was gold. Criteria, the sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, positive predictive value, negative predictive value and diagnostic accuracy were calculated by quantitative analysis of the naked eye, nIC quantitative analysis and combined diagnosis of restenosis in coronary artery stents, and the differences between the three methods were compared with the gold standard respectively by x2 test. Finally, X2 was used. There was no difference between the qualitative analysis of the naked eye, nIC quantitative analysis and the accuracy of the diagnosis of coronary artery stenting restenosis. All statistical analysis were processed by SPSS Statistics version 21 and MedCalc software. The difference of P0.05 was statistically significant. Results: 86 coronary arteries CT were obtained by 1. scan. The image quality score of the angiography was 1~4, with an average of 1.86 + 0.78.2. in the 152 stents of the gold standard, no narrow stent 75, 49.34%, 29 for mild stenosis, 19.08%, 17 for mild stenosis, 11.18%, 7 for moderate stenosis, 4.60%, 13, 8.55%, and totally blocked stent. A total of 31 stents (7.24%. stenosis or more than 50%) accounted for a total of 31 stents. 103 (67.76%), 13 stents (8.55%) for mild stenosis, 11 (7.24%) for mild stenosis, 3 (1.97%) for moderate stenosis, 13 (8.55%) in severe stenotic stents and 9 (5.92%) in severe stenosis, were found in the qualitative analysis of 20.39%.3. naked eyes. 25 stents were significantly narrowed, accounting for the sensitivity of 16.45%. in the diagnosis of coronary artery stent stenosis, specificity, positive likelihood ratio, negative likelihood ratio, positive predictive value, negative predictive value, and diagnostic accuracy of 67.74%, 96.69%, 20.49,0.33,84%, 92.13%, 90.79%, respectively, and there was no statistical difference from the results of selective coronary angiography. 4.nIC quantitative analysis was used to detect 27 significant stenotic stents (17.76%) and 125 (82.24%) without significant stenosis. The sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, positive predictive value, negative predictive value, and diagnostic accuracy were 58.06%, 92.56%, 7.81,0.45,66.67%, 89.60%, respectively, in the diagnosis of coronary artery stent stenosis. 85.53%, the difference between the results obtained from the selective coronary angiography was not statistically significant. 5. the quantitative analysis of the coronary artery stents, 35 (23.03%) and no significant narrowing stents (76.97%) were detected by quantitative analysis of nIC, and the sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, positive likelihood ratio, positive likelihood ratio, positive likelihood ratio, positive likelihood ratio, positive likelihood ratio, positive likelihood ratio, positive likelihood ratio, positive likelihood ratio, and positive likelihood ratio of the coronary artery stents were diagnosed. The predictive value, negative predictive value and diagnostic accuracy were 83.87%, 92.56%, 11.28,0.17,74.29%, 95.73%, 90.79, and the difference between the results obtained from the selective coronary angiography was not statistically significant. 6. qualitative analysis of the naked eyes, nIC quantitative analysis and the combination of the two methods to evaluate the accuracy of the significant stenoses in the stent after coronary stenting. The differences between the markers are not statistically significant. Conclusion: 1. dual source CT dual energy scanning images can clearly show the position of the stent implantation and the filling degree in the lumen, and can accurately distinguish the stent restenosis, classify, clear the cause and range of the narrow narrow, and 2. dual source dual energy scanning. A clear iodine distribution map was obtained. By measuring the iodine content in the stent, the sensitivity of the stent restenosis was greatly improved, but the specificity decreased because of its high false positive. 3. dual source CT dual energy scanning has preliminarily realized the quantitative analysis of the stent restenosis by CT, and the analysis of the plaque properties of the stent and the deficiency of the myocardium. The quantitative analysis of blood judgment laid a solid foundation.

【学位授予单位】：兰州大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R541.4;R816.2

【参考文献】