本文關(guān)鍵詞： 冠狀動脈 Agatston積分 冠狀動脈鈣化 CT血管成像 冠狀動脈 冠狀動脈鈣化 CT血管成像 狹窄　出處：《泰山醫(yī)學(xué)院》2013年碩士論文　論文類型：學(xué)位論文

【摘要】：第一部分冠狀動脈鈣化積分評價的新方法及臨床應(yīng)用的初步探討 目的 探討在冠狀動脈CT造影（CT coronary angiography，CTCA）中評估鈣化積分的準(zhǔn)確性以及對冠狀動脈顯著狹窄的預(yù)測能力，減少病人的輻射劑量。 方法 前瞻性研究包括73名患者(女性25名，男性48名，平均年齡60.27±9.78歲，年齡范圍34-82歲)，使用320排容積CT進行掃描，并對傳統(tǒng)鈣化積分圖像及CTCA圖像中分別評估鈣化積分。利用Spearman相關(guān)分析評價兩者的相關(guān)性。利用ROC工作曲線，，以ICA結(jié)果為參考標(biāo)準(zhǔn)，對比傳統(tǒng)鈣化積分與造影后鈣化積分預(yù)測冠狀動脈管腔顯著狹窄的診斷能力。 結(jié)果 傳統(tǒng)鈣化積分的平均值為365±514，造影后鈣化積分平均值為404±572。兩者呈高度相關(guān)（r值=0.977，P0.01）。傳統(tǒng)的鈣化積分曲線下面積（Area Under the Curve，AUC）為0.859，95%CI (0.774-0.945)，CTCA中評估的鈣化積分AUC為0.863，95%CI(0.779-0.947)。 結(jié)論 CTCA中評估的鈣化積分與傳統(tǒng)平掃鈣化積分有良好的相關(guān)性和準(zhǔn)確性，從而可以略過單純的鈣化積分掃描，進一步降低病人的輻射劑量。 第二部分新鈣化積分與冠狀動脈CT成像聯(lián)合診斷冠狀動脈狹窄 目的 探討新鈣化積分與冠狀動脈CT造影（CT coronary angiography，CTCA）結(jié)合評估冠狀動脈顯著狹窄的能力，從而略過單純的鈣化積分掃描，進一步減低病人的輻射劑量。 方法 前瞻性研究包括73名患者(女性25名，男性48名，平均年齡60.27±9.78歲，年齡范圍34-82歲)，使用320排容積CT進行掃描，在CTCA圖像中評估鈣化積分與冠狀動脈狹窄。利用ROC工作曲線，以ICA結(jié)果為參考標(biāo)準(zhǔn)，評估造影后鈣化積分與CTCA結(jié)合預(yù)測冠狀動脈管腔顯著狹窄的診斷能力。 結(jié)果 新鈣化積分預(yù)測冠狀動脈顯著狹窄的靈敏度為84.6%，特異度為100%，陽性預(yù)測值100%，陰性預(yù)測值71.4%。CTCA評估冠狀動脈狹窄的靈敏度為96.1%；特異度為77.3%；PPV為90.7%；NPV為89.1%。CS與CTCA結(jié)合評估冠狀動脈狹窄的靈敏度為96.1%；特異度為100%；PPV為100%；NPV為91.7%。 結(jié)論 新CS與CTCA結(jié)合評估冠狀動脈狹窄具有良好的準(zhǔn)確性，從而進一步降低了病人的輻射劑量以及掃描時間。
[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 鹵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 鹵514, and the average value of the calcification integral after angiography was 404 鹵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 鹵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.
【學(xué)位授予單位】：泰山醫(yī)學(xué)院
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2013
【分類號】：R816.2

【參考文獻】

相關(guān)期刊論文 前10條

1 何憶雯;秦永文;蕭毅;;64層螺旋CT血管造影在冠狀動脈支架植入術(shù)后再狹窄診斷中的應(yīng)用[J];第二軍醫(yī)大學(xué)學(xué)報;2008年11期

2 陳艷,韓萍,梁波,梁惠民,雷子喬,田志梁,馮敢生;16層螺旋CT冠狀動脈成像與DSA的對照研究[J];放射學(xué)實踐;2005年03期

3 魯錦國;呂濱;戴汝平;蔣世良;唐翔;吳文輝;宋會軍;喬樹賓;;64層螺旋CT冠狀動脈鈣化積分的再認識[J];放射學(xué)實踐;2009年08期

4 田希存;;多層螺旋CT冠狀動脈鈣化積分在冠心病診斷中的臨床應(yīng)用[J];河北醫(yī)藥;2012年13期

5 嚴麗麗;沈倩波;甘繼宏;楊晶晶;魏雅娜;馬麗群;;雙源CT冠狀動脈成像在冠狀動脈狹窄診斷中的應(yīng)用[J];山東醫(yī)藥;2012年18期

6 孟蕾;劉宇;;冠狀動脈鈣化積分在冠心病診斷及風(fēng)險預(yù)測的臨床價值[J];實用心腦肺血管病雜志;2010年05期

7 明小春;馮慶志;陳觀尚;;64層螺旋CT冠狀動脈成像評價冠狀動脈鈣化與狹窄的臨床應(yīng)用研究[J];實用醫(yī)學(xué)影像雜志;2010年01期

8 張建生;郭寧;王亮;徐川;覃杰;單鴻;;320排動態(tài)容積CT冠狀動脈成像低劑量掃描的初步探討[J];實用醫(yī)技雜志;2009年09期

9 王治中;楊進華;萬琪琳;程冠昌;;應(yīng)用320排CT評價冠狀動脈狹窄的臨床研究[J];中國醫(yī)學(xué)計算機成像雜志;2012年03期

10 肖喜剛,韓雪,王雪紅,孫宏亮,王鴻振,牛洪濤;多層螺旋CT冠狀動脈成像在冠心病中的臨床應(yīng)用[J];中華放射學(xué)雜志;2004年09期

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