320排动态容积CT评估钙化斑块对诊断冠状动脉狭窄程度的影响

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摘要目的：分析不同程度钙化斑块对320排动态容积CT冠状动脉成像（320-CCTA）评估冠脉狭窄的影响。方法：回顾性分析161例接受320-CCTA检查，并于4周内接受冠状动脉造影（CAG）检查的冠心病疑诊患者的临床资料。以CAG为“金标准”，判断320-CCTA诊断伴不同程度钙化斑块冠状动脉狭窄的准确性；对照CAG结果，绘制320-CCTA的受试者工作特征曲线（ROC曲线）并计算曲线下面积（AUC）值。结果：161例320-CCTA图像质量为4分121例（占75.2%），3分40例（占24.8%）。全部病例无阶梯伪影及运动伪影。182（占7.9%）冠脉节段中发现不同程度钙化斑块，其中轻度钙化斑块136（占5.9%）、中度钙化斑块39（占1.7%）、重度钙化斑块7（占0.3%）。320-CCTA诊断冠状动脉狭窄≥50%的敏感性、特异性：非钙化斑组为98.3%、81.3%，混合斑块组为100%、86.2%，轻度钙化78.6%、99.2%，中度钙化90%、86.2%，重度钙化100%、66.7%，其ROC曲线AUC值分别为0.90、0.93、0.89、0.88和0.83。结论：受重度钙化影响，320-CCTA诊断冠脉狭窄≥50%的准确性有所降低，但总体上具有较高的准确性。

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	谢福荣
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	姜亿一
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	吴恩福

关键词 ：体层摄影术, X线计算机；冠状动脉造影；斑块；曲线下面积

Abstract：Objective: To investigate the diagnostic accuracy of 320-slice dynamic volume coronary CT angiography (320-CCTA) in detecting coronary stenosis and to analyze the impact of coronary calcium in different calcification burden groups. Methods: The retrospective analysis enrolled 161 cases undergoing 320-CCTA and thereafter invasive coronary angiography (CAG) within 4 weeks for suspected coronary artery disease. Compared to CAG, the pretest probability of coronary stenosis was analyzed; the receiver operation characteristic (ROC) curve and area under curve of ROC (AUC) were used for statistical analyses. Results: Of 161 patients, 121 cases (75.2%) with optimal imaging quality (scale 4), 40 patients (24.8%) with adequate quality (scale 3). No any stair-step artifact or motion artifact in all cases. A total of 182 (7.9%) segments had some degree of calcification, of all segments, 136 (5.9%) had lightly calcification, 39 (1.7%) had moderate calcification, 7 (0.3%) had severely calcification. The sensitivity and specificity of 320-CCTA for detecting coronary stenosis were at least 50%: noncalcified plaque group (NCP) 98.3%, 81.3%, mixture plaque group (MP) 100%, 86.2%, lightly calcified plaque group (LCP) 78.6%, 99.2%, moderately calcified plaque group (MCP) 90%, 86.2%, severely calcified plaque group (SCP) 100%, 66.7%, the AUC was 0.90, 0.93, 0.89, 0.88, 0.83, respectively. Conclusion: Generally 320-CCTA provides high diagnostic accuracy; but the accuracy will be decreased due to severely calcification.

Key words： tomography, x-ray computed coronary angiography plaque AUC

收稿日期: 2014-10-14

基金资助:温州市公益性科技计划项目（Y20140613）。

通讯作者: 吴恩福，主任医师，硕士生导师，Email：wzwef@163.com。

作者简介: 谢福荣（1982-），男，江西于都人，住院医师，在职硕士生。

链接本文:

https://xb.wmu.edu.cn/CN/ 或 https://xb.wmu.edu.cn/CN/Y2015/V45/I8/570

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