冠状动脉钙化积分评价的新方法及其与CTCA结合评估冠状动脉狭窄临床应用的初步探讨

发布时间：2018-01-29 12:32

本文关键词： 冠状动脉 Agatston积分冠状动脉钙化 CT血管成像冠状动脉冠状动脉钙化 CT血管成像狭窄　出处：《泰山医学院》2013年硕士论文　论文类型：学位论文

【摘要】：第一部分冠状动脉钙化积分评价的新方法及临床应用的初步探讨目的探讨在冠状动脉CT造影（CT coronary angiography，CTCA）中评估钙化积分的准确性以及对冠状动脉显著狭窄的预测能力，减少病人的辐射剂量。方法前瞻性研究包括73名患者(女性25名，男性48名，平均年龄60.27±9.78岁，年龄范围34-82岁)，使用320排容积CT进行扫描，并对传统钙化积分图像及CTCA图像中分别评估钙化积分。利用Spearman相关分析评价两者的相关性。利用ROC工作曲线，，以ICA结果为参考标准，对比传统钙化积分与造影后钙化积分预测冠状动脉管腔显著狭窄的诊断能力。结果传统钙化积分的平均值为365±514，造影后钙化积分平均值为404±572。两者呈高度相关（r值=0.977，P0.01）。传统的钙化积分曲线下面积（Area Under the Curve，AUC）为0.859，95%CI (0.774-0.945)，CTCA中评估的钙化积分AUC为0.863，95%CI(0.779-0.947)。结论 CTCA中评估的钙化积分与传统平扫钙化积分有良好的相关性和准确性，从而可以略过单纯的钙化积分扫描，进一步降低病人的辐射剂量。第二部分新钙化积分与冠状动脉CT成像联合诊断冠状动脉狭窄目的探讨新钙化积分与冠状动脉CT造影（CT coronary angiography，CTCA）结合评估冠状动脉显著狭窄的能力，从而略过单纯的钙化积分扫描，进一步减低病人的辐射剂量。方法前瞻性研究包括73名患者(女性25名，男性48名，平均年龄60.27±9.78岁，年龄范围34-82岁)，使用320排容积CT进行扫描，在CTCA图像中评估钙化积分与冠状动脉狭窄。利用ROC工作曲线，以ICA结果为参考标准，评估造影后钙化积分与CTCA结合预测冠状动脉管腔显著狭窄的诊断能力。结果新钙化积分预测冠状动脉显著狭窄的灵敏度为84.6%，特异度为100%，阳性预测值100%，阴性预测值71.4%。CTCA评估冠状动脉狭窄的灵敏度为96.1%；特异度为77.3%；PPV为90.7%；NPV为89.1%。CS与CTCA结合评估冠状动脉狭窄的灵敏度为96.1%；特异度为100%；PPV为100%；NPV为91.7%。结论新CS与CTCA结合评估冠状动脉狭窄具有良好的准确性，从而进一步降低了病人的辐射剂量以及扫描时间。
[Abstract]:Part I A New method for evaluating Coronary artery calcification integral and preliminary discussion on its Clinical Application Purpose Objective: to evaluate the accuracy of calcification score and the predictive ability of coronary artery stenosis in coronary CT angiography (CT) and CT angiography (CTCA). Reduce the patient's radiation dose. Method The prospective study included 73 patients (25 females and 48 males, mean age: 60.27 卤9.78 years, age range: 34-82 years). The calcification integral was evaluated in traditional calcification integral image and CTCA image respectively. The correlation between them was evaluated by Spearman correlation analysis. The working curve of ROC was used. The diagnostic ability of traditional calcification score and post-contrast calcification score to predict significant stenosis of coronary artery was compared with ICA results. Results The mean value of the traditional calcification integral was 365 卤514, and the average value of the calcification integral after angiography was 404 卤572. There was a high correlation between the two values (r = 0.977). The area area Under the curve under the traditional calcification integral curve is 0.859. The calcification integral (AUC) assessed in the CI0.774-0.945 CTCA was 0.86395 CI 0.779-0.947. Conclusion There is a good correlation and accuracy between the calcification integral evaluated in CTCA and the traditional plain scan calcification integral, which can skip the simple calcification integral scan and further reduce the radiation dose of the patient. Part two New calcification score combined with Coronary CT Imaging in the diagnosis of Coronary artery Stenosis Purpose Objective to evaluate the ability of new calcification score combined with CT coronary angiography in evaluating significant coronary artery stenosis. Thus skipping the simple calcification integral scan, further reduces the patient's radiation dose. Method The prospective study included 73 patients (25 females and 48 males, mean age: 60.27 卤9.78 years, age range: 34-82 years). Calcification score and coronary artery stenosis were evaluated on CTCA images. ICA results were used as the reference standard using ROC working curve. To evaluate the diagnostic ability of calcification score combined with CTCA in predicting significant stenosis of coronary artery. Results The sensitivity, specificity and positive predictive value of neocalcification score in predicting significant coronary artery stenosis were 84.6 and 100, respectively. The positive predictive value was 100%. The sensitivity of CTCA in evaluating coronary artery stenosis was 96.1; The specificity was 77.3; PPV was 90.7; The sensitivity of NPV, 89.1CS and CTCA in evaluating coronary artery stenosis was 96.1; The specificity was 100. PPV was 100. NPV is 91.7. Conclusion New CS combined with CTCA has good accuracy in evaluating coronary artery stenosis, which further reduces the radiation dose and scanning time.
【学位授予单位】：泰山医学院
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R816.2

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