摘要
目的:与CAG对照分析来评价64层螺旋CT冠状动脉成像在房颤患者中诊断有血流动力学意义的冠状动脉狭窄的准确性。方法:58例房颤患者行64层螺旋CT冠状动脉成像,扫描前均未服用倍它乐克。血管图像质量分为好、中等和差。以CAG作为参考标准,分别基于血管节段和患者水平来分析MDCTCA诊断有血流动力学意义的冠状动脉狭窄的敏感性、特异性、阳性预测价值和阴性预测价值。诊断价值的评价首先仅限于图像质量达到诊断要求的血管节段和患者,进一步的分析中将图像质量不能诊断的血管节段和患者均作为阳性来处理。结果:58例患者有645段(96.55%)图像质量为中等以上,诊断有血流动力学意义的敏感性、特异性、阳性预测价值和阴性预测价值分别是86.21%(25/29)、99.35%(612/616)、86.21%(25/29)和99.35%(612/616)。将23段图像质量没有达到诊断要求的血管均作为阳性后,CTCA诊断有血流动力学意义的血管狭窄的总体阳性预测价值为48.08%(25/52),特异性为95.77%(612/639)。基于患者总体图像质量的分析,58例患者中有47例(81.03%)图像质量为中等以上,CTCA诊断有血流动力学意义的敏感性、特异性、阳性预测价值和阴性预测价值分别是87.50%(7/8)、97.44%(38/39)、87.50%(7/8)和97.44%(38/39)。将11例图像质量没有达到诊断要求的血管均作为阳性后,CTCA诊断有血流动力学意义的血管狭窄的敏感性、特异性、阳性预测价值和阴性预测价值分别是90.00%(9/10)、79.17%(38/48)、47.37%(9/19)和97.44%(38/39)。结论:64CTCA在房颤患者中诊断有血流动力学意义的冠状动脉狭窄具有较好的阴性预测价值,但需要进一步提高图像质量来提高诊断血管狭窄的准确性。
Purpose：To evaluate the accuracy of 64-CTCA for detecting significant stenosis in patients with atrial fibrillation（AF）.Methods：Fifty-eight patients with AF underwent 64-detector row CTcoronary angiography.No beta-blocker was taken in all patients.The image quality of each segment and patient was evaluated as good,moderate and poor.The sensitivity,specificity,PPV and NPV of 64-CTCA for the diagnosis of significant stenosis were evaluated by using CAG as a reference standard in the segment-based and patient-based analysis.First,the evaluation was only confined to those segments and patients with good and moderate image quality;in a second step,analysis was repeated in all segments and patients that were classified as poor image quality in CTCA,they were rated as positive.Results： Of the 668 segments,645（96.55%） were evaluated as good or moderate.The sensitivity,specificity,PPV and NPV for the diagnosis of significant stenosis by 64-CTCA were 86.21%（25/29）,99.35%（612/616）,86.21%（25/29） and 99.35%（612/616）,respectively.Classifying segments with poor image quality as positive,the specificity and PPV were 95.77%（612/639） and 48.08%（25/52）,respectively.Of the 58 patients,47（81.03%） were evaluated as good or moderate.The sensitivity,specificity,PPV and NPV were 87.50%（7/8）,97.44%（38/39）,87.50%（7/8） and 97.44%（38/39）,respectively.Classifying patients with poor image quality as positive,overall sensitivity,specificity,PPV and NPV were 90.00%（9/10）,79.17%（38/48）,47.37%（9/19） and 97.44%（38/39）,respectively. Conclusion： 64-CTCA has high NPV in detecting significant stenosis of coronary arteries in patients with AF,but the image quality need to be improved for the higher accuracy of detecting the significant stenosis.
出处
《中国医学计算机成像杂志》
CSCD
北大核心
2010年第6期487-492,共6页
Chinese Computed Medical Imaging
基金
广东省自然科学基金项目(项目编号:8151008901000210)
广东省科技计划项目(项目编号:2006B36007007)~~
