摘要
目的：前瞻性评价对比增强磁共振全心冠状动脉成像（ CE-CMRA ）对冠心病的诊断价值。方法连续搜集河南省人民医院2009年6月至2012年12月72例可疑冠心病患者，拟行传统冠脉造影行3.0 T对比增强磁共振全心冠脉成像。将CE-CMRA的显像质量、冠脉狭窄程度分别与传统冠脉造影（ CAG）相对比。结果72例患者中成功完成CE-CMRA检查65例。 CAG显示管腔直径≥1.5 mm的冠脉血管共809个节段中， CE-MRA显示可评价血管704段，不可评价血管105段（13.0％）。 CAG诊断冠心病38例，排除冠心病27例。如果将105段不能评价的冠脉判读为明显狭窄，CE-CMRA正确诊断38例冠心病患者中的36例，正确排除27例非冠心病患者中的21例。以冠脉节段改变为评价单位， CE-CMRA诊断冠心病的敏感性、特异性分别为93.8％、85.4％，阳性预测值、阴性预测值分别为53.2％、98.9％；以患者为评价单位，CE-MRA诊断冠心病的敏感性、特异性分别为94.7％、77.8％，阳性预测值和阴性预测值分别为85.7％和91.3％。结论 CE-CMRA在冠心病诊断中可提供较高的诊断敏感性、阴性预测值，中等度的特异性、阳性预测值，将来有望作为冠心病筛查的有效辅助影像检查方法。
Objective To prospectively evaluate the diagnostic effectiveness of contrast-enhanced whole-heart coronary magnetic resonance angiography （ CE-CMRA） in patients with suspected coronary artery disease（CAD） with conventional coronary angiography as the reference standard.Methods A total of 72 subjects with suspected CAD scheduled for conventional coronary angiography underwent 3.0-T contrast-enhanced whole-heart CE-MRA.The imaging quality , diagnostic performance and accuracy of CE-MRA for detecting significant stenoses （≥50%） in coronary arteries were compared with that of quantitative coronary angiography（ QCA）.Results The whole-heart CE-MRA examinations were successfully completed in 65 patients.Among 809 segments with a reference luminal diameter ≥1.5 mm on CAG, 105 segments on CE-MRA were evaluated as nonassessable （ 13.0%） and 704 segments assessable.If 105 nonassessable segments on CE-MRA were considered to have significant stenoses , CE-MRA correctly identified CAD in 36/38 patients and correctly ruled out CAD in 21/27 patients.CE-MRA yielded 93.8%,85.4%,53.2%and 98.9%for diagnostic sensitivity,specificity,positive predicative value （PPV） and negative predicative value（NPV） on the basis of per-segment versus 94.7%,77.8%,85.7% and 91.3% respectively on the basis of per-patient.Conclusion CE-CMRA provides sufficiently high sensitivity and NPV ,but moderate specificity and PPV for the diagnosis of CAD.It may be used as an optional imaging modality for CAD screening.
出处
《中华医学杂志》
CAS
CSCD
北大核心
2014年第21期1605-1608,共4页
National Medical Journal of China
基金
河南省卫生科技攻关计划（2011020142）
河南省卫生科技攻关计划（201003101）
关键词
磁共振成像
冠状动脉疾病
磁共振血管造影术
Magnetic resonance imaging
Coronary artery disease
Magnetic resonance angiography
