多层螺旋CT 冠状动脉成像质量及对冠状动脉
病变诊断准确性的评价
黄美萍 刘其顺 刘辉 梁长虹 张绍斌
【摘要】 目的 探讨64 层螺旋CT( MDCT) 冠状动脉成像的图像质量及诊断冠状动脉病变的准
确性。方法 105 例患者( 包括高心率、冠状动脉钙化及肥胖病例, 但除外房颤病例) 作MDCT 冠状动
脉成像, 并与常规冠状动脉造影对照。分析MDCT 图像质量及对冠状动脉病灶的显示情况。结果
每例均对冠状动脉的13 个节段进行分析( 共1365 个节段) 。1144 个节段能满足管腔评价, 221 个节
段因钙化严重( 153 个节段) 或运动伪影( 68 个节段) 无法满足管腔评价。105 例中钙化积分中位数为
154( 范围0 ～1983) ; 87 例钙化积分< 1000, 中位数105( 范围0 ～994) ; 18 例钙化积分≥1000, 中位数
1477( 范围1115 ～1983) 。MDCT 发现≥50% 狭窄总的敏感度、特异度、阳性预测值、阴性预测值分别
为85. 7% 、97. 9% 、93. 0% 、95. 5% 。当评价局限在钙化积分< 1000 的患者时, MDCT 发现≥50% 狭窄
的敏感度、特异度、阳性预测值、阴性预测值分别为96. 0% 、98. 9% 、95. 3% 、99. 0% 。临床正确诊断率
( 发现或排除至少1 个有意义病灶) 为92. 4% ( 97 /105) 。结论 对非选择性病例, MDCT 可提供高诊
断准确性的冠状动脉图像。
【关键词】 冠状动脉疾病; 体层摄影术, X 线计算机; 血管造影术
Multidetector CT of the cor onar y imaging: assessment of image quality a nd a ccura cy in detecting
stenoses HUANG Mei-ping, LIU Qi-shun, LIU Hui, LIANG Cha ng-hong, ZHANG Sha o-bin. Department
of Radiology, Guangdong Provincial People′s Hospital, Gua ngzhou 510080, China
Corresponding author: LIANG Cha ng-hong, Ema il: dr_lia ng62@hotmail. com
【Abstra ct 】 Objective To evaluate the image quality of 64-multi detector computed tomography
( MDCT) and the clinical accuracy in detecting coronary artery lesions. Methods One hundred and five
patients were studied by MDCT. The results were compared with invasive coronary angiography ( ICA) .
Patients were excluded for atrial fibrillation, but not for high heart rate, coronary calcification, or obesity.
MDCT was analyzed with regard to image quality and presence of coronary artery lesions. Results The data
evaluation of the image quality was based on a total of 1365 segments ( 13 coronary segments for each
patient) , of which 1144 segments were considered to have diagnostic image quality, but 221 segments
( 16. 2% ) could not be sufficiently evaluated because of severe calcifications ( 153 segments ) and motion
artifacts ( 68 segments ) . The median calcium score [ Agatston score equivalent ( ASE) ] was 154 ( range
0—1983) . 87 of the 105 patients had an ASE of less than 1, 000 [ median 105 ( range 0—994) ] , and
18 patients had an ASE greater than 1000 [ median 1477 ( range 1115—1983) ] . For detecting lesions with
50% or greater narrowing ( without any exclusion criteria ) , the overall sensitivity, specificity, positive
predictive value, and negative predictive value were 85. 7% , 97. 9% , 93. 0% , and 95. 5% , respectively.
When limiting the number of patients to those with a calcium score of less than 1000 ASE, the thresholdcorrected
sensitivity for lesions with 50% or greater narrowing was 96. 0% ; specificity, 98. 9% ; positive
predictive value, 95. 3% ; and negative predictive value, 99. 0% . Conclusion Our results indicate high
quantitative and qualitative diagnostic accuracy of 64-slice MSCT in comparison to QCA in a broad spectrum
of patients.
【Key wor ds】 Coronary disease; Tomography, X-ray computed; Angiography

多层螺旋CT 冠状动脉成像质量及对冠状动脉--心血管.rar