摘要
目的 探讨双源CT冠状动脉(下称冠脉)成像(DSCT-CA)在冠脉狭窄病变及斑块性质诊断中的应用价值.方法 选取2019年10月至2022年2月西湖大学医学院附属杭州市第一人民医院收治的 200例疑似冠心病(CHD)患者为研究对象,均接受冠脉血管造影、DSCT-CA检查,以冠脉造影诊断结果为金标准评估DSCT-CA诊断冠脉狭窄病变的价值;80例经冠脉造影确诊为CHD的患者同时接受血管内超声(IVUS)检查,比较DSCT-CA与IVUS测得的CHD患者冠脉斑块参数[包括血管外膜内面积(EEM CSA)、最小管腔面积(MLA)、斑块面积(PA)、斑块负荷(PB)、重构指数(RI)、偏性指数(EI)],同时以IVUS诊断结果为金标准评估DSCT-CA诊断斑块性质的价值.结果 经冠脉造影检查确诊为CHD 117例,非CHD 83例;冠脉无狭窄83例,轻度狭窄33例,中度狭窄45例,重度狭窄39例.DSCT-CA正确诊断冠脉无狭窄76例,轻度狭窄28例,中度狭窄 40 例,重度狭窄 36 例;DSCT-CA与冠脉造影诊断冠脉狭窄程度的一致性较高(Kappa=0.953,P＜0.001).DSCT-CA正确诊断CHD 104例,正确排除CHD 76例;漏诊率、误诊率分别为11.1%、84.3%;DSCT-CA诊断CHD患者的灵敏度、特异度、AUC分别为0.889、0.916、0.902.DSCT-CA诊断无狭窄、左冠脉主干狭窄、左前降支狭窄、回旋支狭窄、右冠脉狭窄的准确度分别为 91.6%、92.9%、93.1%、84.6%、92.9%.DSCT-CA与IVUS测得的CHD患者EEM CSA、MLA、PA、PB、RI、EI比较,差异均无统计学意义(均P＞0.05).DSCT-CA正确诊断易损性斑块98个,非易损性斑块76个;漏诊率、误诊率分别为12.5%、8.4%;DSCT-CA诊断易损性斑块的灵敏度、特异度、AUC分别为0.875、0.916、0.884.结论 DSCT-CA在冠脉狭窄病变及斑块性质诊断中具有一定的价值,且较冠脉造影、IVUS具有无创优势.
Abstract
Objective To explore the application value of dual-source CT coronary angiography(DSCT-CA)in detecting coronary artery stenosis and plaque characteristics.Methods Two hundred patients with suspected coronary heart disease(CHD)admitted to Hangzhou First People's Hospital Affiliated to Westlake University School of Medicine from October 2019 to February 2022 were enrolled.All patients underwent coronary angiography and DSCT-CA examinations.The value of DSCT-CA in diagnosing coronary stenosis were determined based on the results of coronary angiography.Among them,80 cases with coronary stenosis underwent intravascular ultrasound(IVUS)examination.The coronary plaque parameters of CHD[external elastic membrane cross-sectional area(EEM CSA),minimum lumen area(MLA),plaque area(PA),plaque burden(PB),remodeling index(RI),and eccentricity index(EI)]were compared between DSCT-CA and IVUS measurements.The value of DSCT-CA in diagnosing plaque characteristics was evaluated based on IVUS results.Results One hundred and seventeen were diagnosed with CHD through coronary angiography,while 83 were not.Of those diagnosed with CHD,83 had no stenosis,33 had mild stenosis,45 had moderate stenosis,and 39 had severe stenosis.DSCT-CA correctly diagnosed 76 cases with no stenosis,28 with mild stenosis,40 with moderate stenosis,and 36 with severe stenosis.The consistency between DSCT-CA and coronary angiography in diagnosing the degree of coronary artery stenosis was high(Kappa=0.953,P＜0.001).DSCT-CA correctly diagnosed CHD in 104 cases and correctly ruled out CHD in 76 cases;the missed diagnosis rate and misdiagnosis rate were 11.1%and 84.3%,respectively.The sensitivity,specificity,and AUC of DSCT-CA in diagnosing CHD patients were 0.889,0.916,and 0.902,respectively.DSCT-CA diagnosed no stenosis,left main coronary artery stenosis,left anterior descending artery stenosis,circumflex artery stenosis,and right coronary artery stenosis with accuracies of 91.6%,92.9%,93.1%,84.6%,and 92.9%,respectively.DSCT-CA and IVUS mea-surements of EEM CSA,MLA,PA,PB,RI,and EI in CHD patients were compared(all P＞0.05).DSCT-CA correctly diagnosed 98 vulnerable plaques and 76 non-vulnerable plaques;the missed diagnosis rate and misdiagnosis rate were 12.5%and 8.4%,respectively.The sensitivity,specificity,and AUC of DSCT-CA in diagnosing vulnerable plaques were 0.875,0.916,and 0.884,respectively.Conclusion DSCT-CA has certain value in the diagnosis of coronary artery stenosis and plaque characteristics,and it has the advantage of being non-invasive compared to coronary angiography and IVUS.
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