冠状动脉DSCT血管成像在评估冠状动脉侧支循环中的应用价值

发布时间：2018-11-06 17:20

【摘要】：目的评估双源CT(DSCT)显示冠状动脉侧支循环(CCC)的能力。方法回顾性分析2013年1月至2014年12月在本院行冠状动脉CTA检查图像质量良好、并且在4周内经冠状动脉造影(CAG)检查证实至少有一处冠状动脉主要分支闭塞患者资料。以CAG为金标准评估双源CT冠状动脉血管成像(CTA)发现侧支循环的敏感度和特异度,并且以Rentrop分级法为标准评价CTA误诊和漏诊的情况。在CAG图像上按照Rentrop分级法评估冠状动脉侧支循环情况,在DSCT图像上按照新的冠状动脉分级方法评价,应用Kappa系数检验评估这两种分级标准的一致性。结果共有125例患者入组,其中69例患者CAG影像上发现至少1处CCC。以CAG为金标准,双源CTA发现CCC患者的敏感度为73.9%,特异度为87.5%;发现CCC血管的敏感度为80.7%。将CAG和CTA诊断的CCC按照各自标准分级,两种分级标准间存在较高的一致性(K=0.608,P=0.000)。CTA漏诊的17处病变中,包括13处Rentrop 1级、1处Rentrop 2级和3处Rentrop 3级。误诊的6处中,有3处被误诊断为Rentrop 1级、3处被误诊断为Rentrop 2级。结论尽管对部分侧支循环及小的血管显示欠佳,但在冠状动脉血管闭塞患者中CTA依然能准确发现侧支循环。
[Abstract]:Objective to evaluate the ability of dual source CT (DSCT) to display coronary collateral circulation (CCC). Methods from January 2013 to December 2014, the images of coronary artery CTA in our hospital were analyzed retrospectively. At least one patient with coronary artery occlusion was confirmed by coronary angiography (CAG) within 4 weeks. The sensitivity and specificity of double-source CT coronary angiography (CTA) in detecting collateral circulation were evaluated by using CAG as gold standard, and the misdiagnosis and missed diagnosis of CTA were evaluated by Rentrop classification. The collateral circulation of coronary artery was evaluated by Rentrop classification method on CAG images and by new coronary artery grading method on DSCT images. The consistency of the two classification criteria was evaluated by Kappa coefficient test. Results A total of 125 patients were enrolled, 69 of whom found at least 1 CCC. on CAG images. Using CAG as gold standard, the sensitivity and specificity of double-source CTA in detecting CCC were 73.9 and 87.5, respectively, and the sensitivity of CCC vessels was 80.7. The CCC diagnosed by CAG and CTA were classified according to their respective criteria. There was a high consistency between the two classification standards (KG 0.608). CTA 0.000). CTA missed 17 lesions, including 13 Rentrop grade 1, 1 Rentrop grade 2 and 3 Rentrop grade 3). Of the 6 misdiagnosed cases, 3 were misdiagnosed as Rentrop grade 1 and 3 as Rentrop grade 2. Conclusion in spite of the poor display of partial collateral circulation and small vessels, CTA can still accurately detect the collateral circulation in patients with coronary artery occlusion.
【作者单位】：徐州医科大学附属医院影像科;徐州医科大学附属医院心内科;
【分类号】：R541.4;R816.2

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