64层CTA评价冠状动脉侧支循环的能力:与冠状动脉造影的比较

摘要

目的 评价冠状动脉CT血管成像(CTA)显示冠状动脉侧支循环的敏感度、特异度,并与冠状动脉造影比较.资料与方法 回顾性分析2005年6月-2012年5月到我院行CTA检查,并经随后的冠状动脉造影(CAG)证实的1支或以上冠状动脉完全闭塞(100％狭窄)和次全闭塞(95％～99％狭窄)病人,判断CTA检测冠状动脉侧支循环(CCC)的准确性,并以Rentrop分级法为标准评价CTA的误漏诊情况.结果 冠状动脉闭塞或次全闭塞病人共58例,24例病人CTA发现有1支或以上CCC建立,27例病人CAG发现有1支或以上CCC建立,以CAG为金标准,64层CTA发现CCC的敏感度为85.16％ (23/27),特异度为96.77％ (30/31).CTA漏诊的14处均为CAG1级,CTA误诊的6处包括CAG1级1处、CAG2级4处,CAG3级1处.CAG和CTA对CCC的分级标准间存在较高的一致性(κ=0.844,P＜0.05).结论 64层CTA可粗略地评价冠状动脉闭塞病变和侧支循环.%Objective Taking traditional coronary angiography (CAG) as the reference standard,to evaluate the sensitivity and specificity of computed tomography angiography (CTA) in demonstrating coronary collateral circulation (CCC).Materials and Methods Retrospectively selected 58 patients with complete or sub-total occlusion at least one major coronary artery on CTA.Taking traditional CAG as the reference standard,we evaluated the accuracy of the CTA to detect the CCCs and analyzed the misdiagnosis and missed diagnosis of CTA according to the Rentrop grading.Results Among the 58patients,at least one CCC was detected by CTA in 24 patients,and in 27 patients by CAG.Taken the CAG results as the reference standard,the sensitivity and specificity of the 64 CTA in detecting patients with the CCCs were 85.16％ (23/27) and 96.77％ (30/31) respectively.The 14 misdiagnosis were all CAG-1 in Rentrop grading,and the 6 misdiagnosis included 1CAG-1,4 CAG-2,and 1 CAG-3.The consistency of the two grading criteria was relatively high (κ=0.844,P＜0.05).Conclusion 64 CTA can accurately evaluate the coronary collateral circulation.