| 引用本文： |
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黄群,李芳,胡绮莉,等.管腔内CT值对冠状动脉狭窄程度的评估价值[J].同济大学学报（医学版）,2021,42(2):248-253. [点击复制]
- HUANG Qun,LI Fang,HU Qi-li,et al.Intraluminal CT values for evaluating stenosis of coronary artery[J].同济大学学报（医学版）,2021,42(2):248-253. [点击复制]
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| 摘要: |
| 目的管腔内CT值对冠状动脉狭窄程度准确性评估的价值研究。方法回顾性分析15 d内先后行冠状动脉CT血管成像（coronary computed tomography angiography, CCTA）和数字减影血管造影（digital subtraction angiography, DSA）患者的CCTA图像，纳入93例患者的148支血管，测量其狭窄近侧和远侧及对应同层面降主动脉CT值，记为A1、A2、B1、B2，定义校正的管腔内CT值差值（definition of corrected coronary opacification, DCCO)=A1/B1－A2 /B2。以DSA检查结果为标准，将纳入血管分为3组： 轻度狭窄组，中度狭窄组，重度狭窄组；根据斑块性质，将纯钙化斑块纳入钙化组，混杂斑块及软斑块纳入非钙化组。比较分析常规CCTA、DCCO和DCCO联合CCTA对冠状动脉狭窄程度诊断的准确率。结果轻度、中度、重度狭窄组DCCO值分别为： 0.06±0.01、0.13±0.18、0.21±0.02，冠状动脉狭窄程度越严重，对应DCCO值越大，组间两两比较DCCO值存在差异且具有统计学意义（P<0.05）。CCTA、DCCO及DCCO联合CCTA评估狭窄程度效能比较： 分别以狭窄程度≥50%和狭窄程度≥75%为阳性事件绘制ROC曲线： CCTA、DCCO、DCCO+CCTA诊断冠状动脉狭窄程度ROC曲线下面积分别为0.691、0.699、0.767和0.761、0.717、0.821，DCOO最佳截断值分别为0.131、0.135，灵敏度分别为0.511、0.635，特异度分别为0.815、0.75，阳性预测值分别为0.753、0.774，阴性预测值分别为0.712、0.688，可见DCCO联合CCTA对冠状动脉狭窄程度诊断的准确率相较于DCCO和常规CCTA均有所提高。结论与常规CCTA相比，DCCO及DCCO联合CCTA可一定程度上提高对冠状动脉狭窄程度诊断的准确率，作为量化指标评估冠状动脉狭窄程度具有一定临床价值。 |
| 关键词: 冠状动脉CT血管成像 管腔CT值 冠状动脉 狭窄 |
| DOI：10.12289/j.issn.1008-0392.20521 |
| 投稿时间：2020-12-05 |
| 基金项目:上海市科委医学引导类（中、西医）科技支撑项目（18411970300） |
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| Intraluminal CT values for evaluating stenosis of coronary artery |
| HUANG Qun,LI Fang,HU Qi-li,LI Yun-fei,Meng Fan-hua,ZHAO Xiao-hu |
| (Dept. of Radiology, Shanghai Fifth Peoples Hospital, Fudan University, Shanghai 200240, China) |
| Abstract: |
| ObjectiveTo explore the diagnostic value of intraluminal CT values in assessment of coronary artery stenosis. MethodsNinety-three patients with coronary artery stenosis（148 arteries) underwent coronary CT angiography（CCTA) and digital subtraction angiography（DSA) were enrolled in the study. The coronary intraluminal CT values proximal and distal to the stenosis within 6-9 mm and the intraluminal CT values in descending aorta on the same axial section were measured, and recorded as A1, A2, B1, and B2, giving the definition of corrected coronary opacification（DCCO)=A1/B1-A2/B2. Based on the results of DSA, the coronary arteries were classified as mild stenosis group, moderate stenosis group and severe stenosis group. Pure calcified plaques were included in the calcified group, and mixed plaques and soft plaques in the non-calcified group, according to the properties of the plaques. The value of CCTA and DCCO and DCCO+CCTA in the diagnosis of coronary artery stenosis was assessed, with DSA results as reference standard. ResultsDCCO values in the mild, moderate and severe stenosis groups were 0.06±0.01, 0.13±0.18, and 0.21±0.02, respectively（P＜0.05). The area under ROC curve（AUC) of CCTA, DCCO and DCCO+CCTA for diagnosis of the 50%, 75% stenosis of coronary artery was 0.691, 0.699, 0.767 and 0.761, 0.717, 0.821. Taking 0.131, 0.135 as cutoff value, the sensitivity, specificity, positive predictive value and negative predictive value of DCOO+CCTA for diagnosis of the 50%, 75% stenosis was 0.511, 0.635; 0.815, 0.75; 0.753, 0.774; and 0.712, 0.688, respectively, which were better than those of single DCCO or CCTA. ConclusionCompared with conventional CCTA, DCCO and DCCO+CCTA might improve the diagnostic accuracy of CCTA for coronary artery stenosis. Using these as quantitative indexes to assess the degree of coronary artery stenosis has certain clinical value. |
| Key words: coronary computed tomography angiography intraluminal CT value coronary artery stenosis |
