CT血管成像对冠心病的诊断价值-东南大学学报医学版

CT血管成像对冠心病的诊断价值

单位：东南大学附属中大医院放射科, 江苏南京 210009

分类号：R541.4;R816.2

出版年·卷·期（页码）：2014·33·第三期（247-254）

摘要：

目的：评估多层螺旋CT血管造影（CTA）对冠状动脉病变诊断的准确率，以期代替常规冠状动脉造影。材料及方法：回顾性收集57例冠心病患者的临床资料，均行冠状动脉造影及多层螺旋冠状动脉CTA成像。共选择931段冠脉进行研究，其中95段表现出不同程度的狭窄：34段狭窄程度<50%，43段狭窄程度为50%~70%，18段狭窄>70%。结果：64排CTA对诊断冠脉狭窄程度<50%、50%~70%及>70%的敏感性及特异性分别为78.57%、99.34%，81.08%、99.33%和87.5%、99.78%；阳性预测值及阴性预测值分别为78.57%、99.34%，83.33%、99.22%和87.5%、99.78%；诊断准确率分别为88.95%、90.2%及93.64%。常规冠脉造影及64排冠脉CTA成像对中度狭窄（50%~70%）及重度狭窄（>70%）的诊断准确率差异无统计学意义（P>0.05），但对轻度狭窄（<50%）的诊断差异有统计学意义（P<0.05）。结论：64排冠脉CTA成像对中重度狭窄的冠脉诊断准确率较高，可以取代常规冠脉造影。

To evaluate the diagnostic efficacy of multi-detector computed tomography angiography (MDCTA) as an alternative to conventional coronary angiography in the assessment of coronary artery disease. Materials and Methods:This retrospective study enrolled 57 patients with coronary artery disease, who underwent both conventional coronary angiography (CCA) and multi-detector computed coronary angiography. Total of 931 accessible segments were studied. Of which 95 segments showed varied degree of stenosis, with 34 segments <50% stenosis, 43 segments 50%-70% stenosis and 18 segments >70% stenosis. Results:The sensitivity and specificity of 64-slice MDCT for detecting stenosis in <50%, 50%-70% and >70% were 78.57% and 99.34%,81.08% and 99.33%,87.5% and 99.78%respectively. The positive predictive value (PPV) and negative predictive value (NPV) were 78.57% and 99.34%,83.33% and 99.22%,87.5% and 99.78% respectively. Over all accuracies were 88.95%, 90.2% and 93.64% respectively. There was no significant difference in diagnostic accuracy between conventional coronary angiography and 64-slice computed tomography in moderate (50%-70%) as well as severe (>70%) stenosis (P>0.05). However, significant difference was found in mild (<50%) stenosis (P<0.05). Conclusion:Diagnostic accuracy of multi-detector computed coronary angiography is found to be higher in moderate and severe stenosis and can be used as an alternate to conventional coronary angiography (CCA).

参考文献：

[1] CHOW B J,VEINOT J P.What are the most useful and trustworthy noninvasive anatomic markers of existing vascular disease?[J].Curr Cardiol Rep,2006,8:439-445.
[2] CHEN J W,WASSERMAN B A.Vulnerable plaque imaging[J].Neuroimaging Clin N Am,2005,15:609-621.
[3] KUNIMASA T,SATO Y,SUGI K,at al Evaluation by multislice computed tomography of atherosclerotic coronary artery plaques in non-culprit,remote coronary arteries of patients with acute coronary syndrome[J].Circ J,2005,69:1346-1351.
[4] HASSAN A,NAZIR S A,ALKADHI H.Technical challenges of coronary CT angiography:today and tomorrow[J].Eur J Radiol,2011,79(2):161-171.
[5] ACHENBACH S,GIESLER T,ROPERS D,et al.Detection of coronary artery stenoses by contrast-enhanced,retrospectively electrocardiographically gated,multislice spiral computed tomography[J].Circulation,2001,103:2535-2538.
[6] BECKER C R,KNEZ A,LEBER A,et al.Initial experiences with multi-slicedetector spiral CT in diagnosis of arteriosclerosis of coronary vessels[J].Radiologe,2000,40:118-122.
[7] BECKER C R,OHNESORGE B M,SCHOEPF U J,et al.Current developmentof cardiac imaging with multidetector-row CT[J].Eur J Radiol,2000,36:97-103.
[8] KOPP A F,OHNESORGE B,FLOHR T,et al.Cardiac multidetector-rowCT:first clinical results of retrospectively ECG-gated spiral withoptimized temporal and spatial resolution[J].Rofo Fortschr Geb Rontgenstr Neuen Bildgeb Verfahr,2000,172:429-435.
[9] KOPP A F,SCHROEDER S,KUETTNER A,et al.Coronary arteries:retrospectivelyECG-gated multi-detector row CT angiography with selectiveoptimization of the image reconstruction window[J].Radiology,2001,221:683-688.
[10] NIEMAN K,OUDKERK M,RENSING B J,et al.Coronary angiography withmulti-slice computed tomography[J].Lancet,2001,357(9256):599-603.
[11] NIEMAN K,VANOOIJEN P,RENSING B,et al.Four-dimensional cardiac imaging with multislice computed tomography[J].Circulation,2001,103:E62.
[12] SCANLON P J,FAXON D P,AUDET A M,et al.ACC/AHA guidelines for coronary angiography:areport of the American College of Cardiology/American Heart Association Task Force onpractice guidelines (Committee on Coronary Angiography).Developed in collaboration with the Society for Cardiac Angiographyand Interventions[J].J Am CollCardiol,1999,33:1756-1824.
[13] AUSTEN W G,EDWARDS J E,FRYE R L,et al.Areporting system on patients evaluated forcoronary artery disease.Report of the AdHoc Committee for Grading of Coronary Artery Disease,Council on Cardiovascular Surgery,American Heart Association[J].Circulation,1975,51:5-40.
[14] KOPP A F,SCHROEDER S,KUETTNER A,et al.Non-invasive coronary angiography with high resolution multidetector-row computed tomography.Results in 102 patients[J].Eur Heart J,2002,23:1714-1725.
[15] KUETTNER A,TRABOLD T,SCHROEDER S,et al.Noninvasive detection of coro-nary lesions using 16-detector multislice spiral computed tomography technology:initial clinical results[J].J Am Coll Cardiol,2004,44:1230-1237.
[16] NIEMAN K,CADEMARTIRI F,LEMOS P A,et al.Reliable noninvasive coro-nary angiography with fast submillimetermultislicespi-ral computed tomography[J].Circulation,2002,106:2051-2054.
[17] MOLLET N R,CADEMARTIRI F,NIEMAN K,et al.Multislice spiral computed tomogra-phy coronary angiography in patients with stable angina pectoris[J].J Am Coll Cardiol,2004,43:2265-2270.
[18] KUETTNER A,KOPP A F,SCHROEDER S,et al.Diagnostic accuracy of multidetector computed tomography coronary angiography in patients with angiographically proven coronary artery disease[J].J Am Coll Cardiol,2004,43:831-839.
[19] ACHENBACH S,ROPERS D,POHLE F K,et al.Detection of [JP3] coronary artery stenoses using multi-detector CT with 16×0.75 collimation and 375 ms rotation[J].Eur Heart J,2005,26:1978-1986.
[20] EHARA M,SURMELY J F,KAWAI M,et al.Diagnostic accuracy of 64-slice computed tomography for detecting angiographically significant coronary artery stenosis in an unselected consecutive patient population:comparison with conven-tional invasive angiography[J].Circ J,2006,70:564-571.
[21] PAUL J F,ABADA H T.Strategies for reduction of radiation dose in cardiac multislice CT[J].Eur Radiol,2007,17:2028-2037.
[22] LESCHKA S,STOLZMANN P,SCHMID F T,et al.Low kilovoltage cardiac dual-source CT:attenuation,noise,and radiation dose[J].Eur Radiol,2008,8(9):1809-1817.
[23] HSIEH J,LONDT J,DUTTA S,et al.High-resolution low-noise reconstruction for EKG-gated chest scans[N].In:Paper presented at:RSNA.2006.
[24] SUPANICH M,ROWLEY H,CHEN G,et al.Dose reduction in neuro CT exams using highly constrained back projection [JP3] (HYPR) techniques[N].In:Paper presented at:RSNA.2006.
[25] HUSMANN L,VALENTA I,GAEMPERLI O,et al.Feasibility of low-dose coronary CT angiography:first experience with prospective ECG-gating[J].Eur Heart J,2008,29(2):191-197.
[26] HUSMANN L,VALENTA I,KAUFMANN P A.Coronary angiography with low-dose computed tomography at 1.4 mSv[J].Herz,2008,33(1):75.
[27] MORGAN-HUGHES G J,ROOBOTTOM C A,OWENS P E,et al.Highly accurate coronary angiography with submillimetre,16-slice computed tomography[J].Heart,2005,91:308-313.
[28] MARTUSCELLI E,ROMAGNOLI A,D'ELISEO A,et al.Accuracy of thin-slice computed tomography in the detection of coronary stenoses[J].Eur Heart J,2004,25:1043-1048.
[29] HEUSCHMID M,KUETTNER A,SCHROEDER S,et al.ECG-gated 16-MDCT of the coronary arteries:assessment of image quality and accuracy in detecting stenoses[J].Am J Roentgenol,2005,184:1413-1419.
[30] MOLLET N R,CADEMARTIRI F,van MIEGHEM C A,et al.High-resolution spiral computed tomography coronary angiography in patients referred for diagnostic conventional [JP3] coronary angiography[J].Circulation,2005,112(15):2318-2323.
[31] LESCHKA S,ALKADHI H,PLASS A,et al.Accuracy of MSCT coronary angiography with 64-slice technology:first experience[J].Eur Heart J,2005,26(15):1482-1487.
[32] THILO C,AULER M,ZWERNER P,at al.Coronary CTA:indications,patient selection,and clinical implications[J].J Thorac Imaging,2007,22(1):35-39.
[33] SHAPIRO M D,BUTLER J,RIEBER J,et al.Analytic approaches to establish the diagnostic accuracy of coronary computed tomography angiography as a tool for clinical decision making[J].Am J Cardiol,2007,99(8):1122-1127.
[34] JANNE D'OTHEE B,SIEBERT U,CURY R,et al.A systematic review on diagnostic accuracy of CT based detection of significant coronary artery disease[J].Eur J Radiol,2008,65(3):449-461.
[35] KALRA M K,MAHER M M,D'SOUZA R,et al. Multidetector computed tomography technology:current status and emerging developments[J].J Comput Assist Tomogr,2004,28(Suppl 1):S2-6.
[36] BRODERICK L S,BROOKS G N,KUHLMAN J E.Anatomic pitfalls of the heart and pericardium.assessment of image quality and accuracy in detecting stenoses[J].Am J Roentgenol,2005,184:1413-1419.
[37] MOLLET N R,CADEMARTIRI F,KRESTIN G P,et al.Improved diagnostic accuracy with 16-row multi-slice computed tomography coronary angiography[J].J Am Coll Cardiol,2005,45:128-132.
[38] HOFFMANN U,MOSELEWSKI F,CURY R C,et al.Predictive value of 16-slice multidetector spiral computed tomography to detect significant obstructive coronary artery disease in patients at high risk for coronary artery disease:patient versus segment-based analysis[J].Circulation,2004,110:2638-2643.
[39] CADEMARTIRI F,MOLLET N R,LEMOS P A,et al.Impact of coronary calcium score on diagnostic accuracy for the detection of significant coronary stenosis with multislice computed tomography angiography[J].Am J Cardiol,2005,95:1225-1227.

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