多層螺旋CT 冠狀動脈成像質量及對冠狀動脈
病變診斷準確性的評價
黃美萍 劉其順 劉輝 梁長虹 張紹斌
【摘要】 目的 探討64 層螺旋CT( MDCT) 冠狀動脈成像的圖像質量及診斷冠狀動脈病變的準
確性。方法 105 例患者( 包括高心率、冠狀動脈鈣化及肥胖病例, 但除外房顫病例) 作MDCT 冠狀動
脈成像, 并與常規冠狀動脈造影對照。分析MDCT 圖像質量及對冠狀動脈病灶的顯示情況。結果
每例均對冠狀動脈的13 個節段進行分析( 共1365 個節段) 。1144 個節段能滿足管腔評價, 221 個節
段因鈣化嚴重( 153 個節段) 或運動偽影( 68 個節段) 無法滿足管腔評價。105 例中鈣化積分中位數為
154( 范圍0 ～1983) ; 87 例鈣化積分< 1000, 中位數105( 范圍0 ～994) ; 18 例鈣化積分≥1000, 中位數
1477( 范圍1115 ～1983) 。MDCT 發現≥50% 狹窄總的敏感度、特異度、陽性預測值、陰性預測值分別
為85. 7% 、97. 9% 、93. 0% 、95. 5% 。當評價局限在鈣化積分< 1000 的患者時, MDCT 發現≥50% 狹窄
的敏感度、特異度、陽性預測值、陰性預測值分別為96. 0% 、98. 9% 、95. 3% 、99. 0% 。臨床正確診斷率
( 發現或排除至少1 個有意義病灶) 為92. 4% ( 97 /105) 。結論 對非選擇性病例, MDCT 可提供高診
斷準確性的冠狀動脈圖像。
【關鍵詞】 冠狀動脈疾病; 體層攝影術, X 線計算機; 血管造影術
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

多層螺旋CT 冠狀動脈成像質量及對冠狀動脈--心血管.rar