多排螺旋CT冠状动脉成像在左主干病变诊断中的应用

摘要

目的 通过多排螺旋CT(MSCT)冠状动脉血管成像(MSCTA)与冠状动脉造影(CAG)在诊断左主干(LMCA)病变方面的对比研究,探讨MSCTA在LMCA斑块定性分析的价值.方法 选择2012年10月～2015年1月就诊于沧州市中心医院的冠状动脉粥样硬化性心脏病患者359例,MSCTA、CAG检查在患者人院1周内完成.将LMCA病变按部位分为近端病变、中段病变、末端病变,以CAG结果为金标准,比较MSCTA在诊断LMCA近端病变、中段病变、末端病变灵敏度、特异性以及与CAG的一致性,同时对LMCA斑块定量和定性分析.结果 以CAG检查为金标准,MSCT和CAG诊断左主干近端和中段病变结果相同,差异无统计学意义(P＞0.05).MSCT诊断左主干末端病变灵敏度为91.2％,特异性为99.4％,漏诊率为6.1％,Kappa值0.917(P＞ 0.05).结论 MSCTA对LMCA病变诊断准确性高,同时可对LMCA斑块定量和定性分析.左主干近端病变和左主干中段病变的诊断结果与CAG检查相同;MSCTA诊断LMCA近端病变的准确性高于远端病变.%Objective To compare the values of multislice spiral computed tomography angiography (MSCTA) and CAG in diagnosis of left main coronary artery (LMCA) lesion,and the value of MSCTA in the qualitative analysis of LMCA plaques.Methods A total of 359 patients examined with MSCTA and CAG in Cangzhou Central Hospital from October 2012 to January 2015 were selected as research objects.The LMCA lesion was divided into:the proximal part,the middle part,and the distal part.Then the sensibility,specificity and consistency in diagnosis of LMCA lesion using MSCT were compared,with CAG as the gold standard.Results Through the comparison,the results were similar in the diagnosis of the proximal,the middle part between MSCTA and CAG,without statistically significant difference (P ＞ 0.05).The sensitivity,specificity,false negative rate for diagnosis in the distal part were 91.2％,99.4％,and 6.1％,Kappa index was 0.917 (P ＞ 0.05).Conclusion MSCTA has high accuracy in diagnosis of LMCA lesion and it can be used for qualitative analysis of LMCA plaques.The results are similar in the diagnosis of the proximal and middle part.The accuracy of MSCT in the diagnosis of proximal LMCA lesions is higher than that of the distal lesions.