双源 CT 和冠状动脉造影评估冠状动脉支架内再狭窄的比较研究

摘要

目的：研究双源 CT（DSCT）和冠状动脉造影（CAG）评估冠状动脉支架内再狭窄的一致性及前者取代后者的可行性。方法137例患者193枚支架均行 CAG 检查及 DSCT 检查判断是否存在支架内再狭窄（ISR），以 CAG 结果为金标准，比较 DSCT 评估支架狭窄的敏感性、特异性、阳性预测值、阴性预测值、准确性。结果137例患者193枚支架，CAG 评估为 ISR 共计61枚，DSCT 正确判断57枚，其敏感性89．4％、特异性88．5％、阳性预测值80．3％、阴性预测值96．7％、准确性90．7％；在 P ＜0．05水准上检验得 Kappa 值为0．5463，DSCT 评估与 CAG 评估 ISR 有较好的一致性；146枚直径≥3．0 mm 支架，CAG 判断46枚 ISR，DSCT 准确判断44枚，其敏感性95．6％、特异性90％、阳性预测值81．5％、阴性预测值97．8％、准确性91．8％；直径＜3．0 mm 的47枚支架，CAG 判断15枚 ISR，DSCT 正确判断13枚，其敏感性86．7％、特异性87．5％、阳性预测值76．5％、阴性预测值93．3％、准确性87．2％。结论DSCT评估 ISR 与 CAG 相比有很好的一致性，但受支架置入部位及大小影响判断，易出现误判及判断 ISR 程度较重，但在大寸径的支架通畅情况的评估基本可以取代 CAG。%Objective To study of dual source CT (DSCT)and coronary angiography (CAG)of dual source CT cor-onary artery restenosis of stent (DSCT)and coronary angiography (CAG)in diagnosis of coronary artery in stent rest-enosis consistency and former feasibility.Methods 137 cases underwent CAG examination of in stent restenosis (ISR) patients received DSCT examination again in the informed consent,evaluating a total of 193 stents in two kinds of in-spection methods of the degree of stenosis.Comparison of DSCT evaluation of stent stenosis sensitivity,specificity,pos-itive predictive value,and negative predictive value,accuracy.Results CAG was evaluated in 137 patients with 193 stents,to determine the ISR a total of 61 medals,DSCT assessment correctly judge the 57 pieces,4 pieces of missed di-agnosis,misdiagnosis 14 pieces,DSCT sensitivity of 89.4%,specificity of 88.5%,positive predictive value of 80.3%, negative predictive value of 96.7%,accuracy of 90.7%;DSCT evaluation and CAG evaluation of ISR are in good agree-ment at the P <0.05 level test,Kappa value was 0.5463;146 pieces of diameter ≥ 3.0mm scaffolds,CAG display 46 stents restenosis,DSCT accurately showed 44 pieces,2 pieces of missed diagnosis,misdiagnosis 10 pieces,DSCT sensi-tivity of 95.6%,specificity of 90%,positive predictive value of 81.5%,negative predictive value of 97.8%,accuracy 91.8%;diameter < 47 3.0mm stents,CAG display 15 pieces of restenosis,DSCT display 13 restenosis,missed 2,mis-diagnosed in 4 pieces,DSCT sensitivity of 86.7%,specificity of 87.5%,positive predictive value of 76.5%,negative predictive value of 93.3%,accuracy of 87.2%.Conclusion Compared DSCT assessment of ISR and CAG have good consistency,sensitivity,satisfactory accuracy,especially in the big inch diameter to assess the patency of stent can re-place the CAG.