摘要
目的:本文旨在研究双屏气模式下CT减影冠状动脉血管成像技术(sub-CCTA)评估支架内再狭窄(ISR)的临床应用价值。材料与方法:前瞻性纳入2022年10月至2023年5月期间接受冠状动脉CT血管成像(CTA)检查支架植入病例。由两名有10年以上心血管阅片经验的影像科医师对减影前后的支架节段图像进行双盲法评估,统计减影前后支架节段可评判率及医师诊断信心,并与有创冠状动脉造影术(ICA)进行比较。诊断准确性通过受试者操作特征曲线(ROC)下面积(AUC)来衡量,以≥50%的狭窄率为临界值,采用多种统计学方法分析sub-CCTA评估支架内再狭窄的临床价值。结果:共分析83名患者161个支架节段,sub-CCTA相较于常规CCTA的不可评估节段从47(29.2%)降到13个(8.1%);医师诊断确信度从(2.55±1.1)上升到(3.86±0.7)。以ICA结果为金标准,共24名患者54个支架节段纳入准段准确性研究,sub-CCTA使诊断准确性从62.6%升到81.7%,假阳性率从35.2%降到5.8%。结论:sub-CCTA可显著提高对支架内再狭窄的诊断准确性,提高支架节段图像的可判读性,增强判读医生的诊断信心,减少患者不必要的有创检查。
Objective:We investigated the clinical value of subtraction coronary computed tomography angiography(sub-CCTA)in double breath-holding mode for assessing in-stent restenosis(ISR).Materials and methods:Records were identified for stent implantation patients who underwent coronary computed tomography angiography(CTA)between October 2022 and May 2023.Images of stented segments before and after subtraction were evaluated via a double-blinded protocol by two physicians with more than 10 years of cardiovascular image reading experience.The percentage of assessable stented segments before and after subtraction and the physician’s diagnostic confidence were calculated and compared with invasive coronary angiography(ICA).Diagnostic accuracy was measured by area under the receiver operating characteristic curve(ROC),with≥50%stenosis as the threshold,and the clinical value of sub-CCTA for assessing in-stent restenosis was analyzed using multiple statistical methods.Results:A total of 182 stented segments in 83 patients were analyzed.The number of non-assessable segments in sub-CCTA compared to con-CCTA decreased from 47(29.2%)to 13(8.1%),and physician diagnostic confidence increased from(2.55±1.1)to(3.86±0.7).Using ICA results as the gold standard,54 stent segments from 24 patients were included in a quasi-segmental accuracy study.Sub-CCTA increased diagnostic accuracy from 62.6%to 81.7%and decreased the false-positive rate from 35.2%to 5.8%.Conclusions:Sub-CCTA significantly improved the accuracy of diagnosing in-stent restenosis and the interpretability of stent segment images,enhanced the diagnostic confidence of interpreting physicians,and reduced unnecessary invasive tests for patients.
作者
周艳
贺毅
李芳
许英浩
马天
钟朝辉
ZHOU Yan;HE Yi;LI Fang;XU Yinghao;MA Tian;ZHONG Chaohui(Department of Radiology,Beijing Friendship Hospital,Capital Medical University,Beijing 100050,China)
出处
《CT理论与应用研究(中英文)》
2025年第4期660-666,共7页
Computerized Tomography Theory and Applications
基金
国家自然科学基金面上项目(基于时序分析神经网络解析室壁形变评估心肌缺血的智能辅助诊断方法研究(82272068))。
