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目的对比冠状动脉内超声(IVUS)检查的结果,评价64层螺旋 CT 冠状动脉成像(MSCTCA)在显示和分析冠状动脉粥样硬化病变方面的可行性和准确性。方法对15例可疑冠心病的患者进行64层 MSCTCA 检查,获取相关的数据,应用后处理技术对冠状动脉粥样斑块进行评估分析,并以3周内实施的 IVUS 结果为金标准进行对比。同时,对2种方法所获得的计量资料(即:血管段某一点的血管腔内面积、血管截面积)进行对比分析,获得直线回归方程(Y:IVUS 值,X:64层MSCT 值)。结果所有病例可用于评估的86个无明显狭窄冠状动脉样本中,IVUS 显示有斑块病变的血管段为38段,64层 MSCTA 显示36段,2段诊断为正常血管。64层 MSCTA 对出现粥样硬化斑块节段诊断的敏感性为94.7%,特异性为100.0%,总符合率为97.7%,误诊率为0,漏诊率为5.3%,阳性预测值100.0%,阴性预测值96.0%。经 Kappa 检验,Kappa 值为0.953,P<0.05。直线回归方程对于2种方法所获得的管腔内面积:Y=0.817+0.832X,P<0.01;血管的截面积:Y=-0.331+1.019X,P<0.01。结论 64层 MSCTCA 在显示冠状动脉粥样硬化斑块病变时,能较为清晰地显示管壁斑块病变的构成情况,对于病变的类型及严重程度的评估比较准确和客观。对于临床怀疑冠心病患者的门诊筛查和初步诊断,具有较好的可行性和准确性。
Objective To evaluate the feasibility and accuracy of 64-slice spiral CT coronary angiography (MSCTCA) in the display and analysis of coronary atherosclerotic lesions by comparing the results of intracoronary ultrasound (IVUS). Methods Fifteen patients with suspected coronary heart disease were examined with 64-slice MSCTCA. Relevant data were obtained. Coronary atherosclerotic plaques were evaluated by post-treatment technique. The IVUS results were compared within 3 weeks as the gold standard. At the same time, the linear regression equation (Y: IVUS value, X: 64th layer MSCT value) was obtained by comparing the measurement data obtained by the two methods (ie, the intravascular area and the vascular cross-sectional area at a certain point in the blood vessel segment). Results All cases were eligible for evaluation in 86 nonsignificantly stenosed coronary arteries. IVUS showed 38 segments of vascular segments with plaque lesions, 36 segments of MSCTA at 64 segments, and normal vessels in segment 2. The sensitivity of 64-slice MSCTA to diagnosis of atherosclerotic plaque was 94.7%, specificity was 100.0%, total coincidence rate was 97.7%, misdiagnosis rate was 0, missed diagnosis rate was 5.3%, positive predictive value was 100.0% Negative predictive value 96.0%. Kappa test showed that the Kappa value was 0.953, P <0.05. Linear regression equation for the two methods obtained intraluminal area: Y = 0.817 + 0.832X, P <0.01; vascular cross-sectional area: Y = -0.331 + 1.019X, P <0.01. Conclusion The 64-layer MSCTCA can show the structure of plaque lesions more clearly when it shows the lesions of coronary atherosclerotic plaque. The evaluation of the type and severity of lesions is more accurate and objective. For clinical suspicion of coronary heart disease screening and initial diagnosis of patients with good feasibility and accuracy.