CT血管成像对冠心病的诊断价值

摘要

Objective:To evaluate the diagnostic efficacy of multi-detector computed tomography angiography (MDCTA) as an alternative to conventional coronary angiography in the assessment of coronary artery disease .Materials and Methods: This retrospective study enrolled 57 patients with coronary artery disease , who underwent both conventional coronary angiography ( CCA ) and multi-detector computed coronary angiography . Total of 931 accessible segments were studied .Of which 95 segments showed varied degree of stenosis , with 34 segments <50%stenosis, 43 segments 50% 70% stenosis and 18 segments >70% stenosis.Results: The sensitivity and specificity of 64-slice MDCT for detecting stenosis in <50%, 50% 70% and >70% were 78 .57% and 99.34%,81.08% and 99.33%,87.5% and 99.78%respectively.The positive predictive value ( PPV) and negative predictive value ( NPV) were 78.57% and 99.34%,83.33% and 99.22%,87.5% and 99.78%respectively.Over all accuracies were 88.95%, 90.2% and 93.64% respectively.There was no significant difference in diagnostic accuracy between conventional coronary angiography and 64-slice computed tomography in moderate (50% 70%) as well as severe ( >70%) stenosis (P>0.05).However, significant difference was found in mild ( <50%) stenosis ( P <0 .05 ) .Conclusion: Diagnostic accuracy of multi-detector computed coronary angiography is found to be higher in moderate and severe stenosis and can be used as an alternate to conventional coronary angiography ( CCA) .%目的：评估多层螺旋CT血管造影（ CTA ）对冠状动脉病变诊断的准确率，以期代替常规冠状动脉造影。材料及方法：回顾性收集57例冠心病患者的临床资料，均行冠状动脉造影及多层螺旋冠状动脉CTA成像。共选择931段冠脉进行研究，其中95段表现出不同程度的狭窄：34段狭窄程度＜50％，43段狭窄程度为50％～70％，18段狭窄＞70％。结果：64排CTA对诊断冠脉狭窄程度＜50％、50％～70％及＞70％的敏感性及特异性分别为78．57％、99．34％，81．08％、99．33％和87．5％、99．78％；阳性预测值及阴性预测值分别为78．57％、99．34％，83．33％、99．22％和87．5％、99．78％；诊断准确率分别为88．95％、90．2％及93．64％。常规冠脉造影及64排冠脉CTA成像对中度狭窄（50％～70％）及重度狭窄（＞70％）的诊断准确率差异无统计学意义（P＞0．05），但对轻度狭窄（＜50％）的诊断差异有统计学意义（P＜0．05）。结论：64排冠脉CTA成像对中重度狭窄的冠脉诊断准确率较高，可以取代常规冠脉造影。