發(fā)布時間：2018-03-30 23:02

  本文選題：冠心病　切入點：CT冠狀動脈成像　出處：《復旦學報(醫(yī)學版)》2017年03期

【摘要】：目的探討CT減影冠狀動脈血管成像(subtraction coronary computed tomography angiography,SubCCTA)在具有嚴重鈣化節(jié)段冠心病中的診斷價值。方法對同時接受320層減影CCTA掃描和傳統(tǒng)冠狀動脈血管造影(digital subtraction angiography,DSA)檢查的27例患者行回顧性分析。對照DSA檢查結(jié)果,分別計算常規(guī)CCTA(conventional CCTA,Con-CCTA)和Sub-CCTA的靈敏度、特異度、陽性預測值、陰性預測值及準確度;采用受試者工作特征(receiver operating characteristic,ROC)曲線評價兩種成像方法的臨床診斷準確性。冠脈病變節(jié)段的狹窄分為Ⅰ、Ⅱ、Ⅲ、Ⅳ4個等級;采用Kappa系數(shù)描述兩種成像方法與DSA結(jié)果之間的一致性。對于剪影前后的圖像質(zhì)量采用4等級評分法,并行t檢驗對比兩者成像質(zhì)量差異。結(jié)果共評估嚴重鈣化節(jié)段52個,其圖像質(zhì)量在Con-CCTA和Sub-CCTA中的得分分別為2.8±0.5和3.4±0.7,兩者間差異有統(tǒng)計學意義(t=5.9,P0.05)。Con-CCTA與DSA對定量評估冠脈狹窄程度的一致性為0.55;Sub-CCTA與DSA之間的一致性為0.81。Con-CCTA診斷冠脈明顯狹窄的靈敏度、特異度、陽性預測值、陰性預測值及準確度分別為81.0%、63.1%、63.1%、81.1%及70.8%;Sub-CCTA各值分別為90.5%、85.2%、82.1%、92.0%及87.5%。與Con-CCTA的ROC曲線下面積0.84(95%CI:0.70~0.93)相比,Sub-CCTA為0.96(95%CI:0.86~1.00),兩者差異有明顯統(tǒng)計學意義(P=0.03)。結(jié)論 Sub-CCTA可以提高嚴重鈣化節(jié)段冠狀動脈狹窄程度的診斷準確性;減影技術(shù)在冠狀動脈成像中的應用可以減少甚至消除嚴重鈣化斑塊產(chǎn)生的偽影,具有較好的臨床應用前景。
[Abstract]:Objective to investigate the diagnostic value of subtraction coronary computed tomography angiographyography (SubCCTAA) in patients with severe calcified coronary heart disease (CHD). Methods to evaluate the diagnostic value of subtraction coronary computed tomography subtraction CCTA and conventional coronary angiography (DSA) in patients with severe calcified coronary artery disease. 27 patients were analyzed retrospectively. Compared with the results of DSA, The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of conventional CCTA(conventional CCTA-CCTA-CCTA-CCTA-CCTAA and Sub-CCTA were calculated respectively. The clinical diagnostic accuracy of two imaging methods was evaluated by receiver operating characteristic curve. The stenosis of coronary artery lesions was divided into four grades: 鈪，

本文編號：1688020