摘要
目的 定性、定量分析斑块性质对320排冠状动脉（冠脉）CT诊断准确性的影响.方法 回顾性分析2008年12月1日至2012年12月31日中山大学附属第三医院行冠脉CT患者资料,以冠脉造影为金标准,计算敏感度、特异度、阳性/阴性预测值及准确度,并使用x2检验、kappa指数（K）、Bland-Altman分析及ROC曲线下面积（AUC）定性、定量评估诊断准确性.结果 共纳入454例患者,分析6 779个血管节段.CT对非钙化斑块的诊断准确性最高;对轻-中度及重度钙化斑块的诊断准确性均下降.对非钙化斑块,CT和CAG结果的一致性优异（κ=0.810）,对钙化斑块则一致性良好（轻-中度钙化,K =0.701;重度钙化,K=0.750）.CT对非钙化斑块诊断正确率高,错误率低;对钙化斑块则反之（P=0.000）.对非钙化（P=0.087）及轻-中度钙化斑块（P =0.704）,CT无明显高估或低估冠脉狭窄;而对重度钙化斑块（P=0.001）,CT则明显高估冠脉狭窄程度.结论 320排CT对非钙化斑块具有良好定性、定量诊断准确性.然而,存在斑块钙化的节段,其定性诊断效能有所降低,定量诊断表现为高估冠脉狭窄。
Objective To investigate qualitatively and quantitatively the diagnostic performance of 320-slice CT for detection of coronary artery disease with respect to different atherosclerotic plaque characteristics.Methods A retrospective search was performed for inpatients underwent both coronary CT and further coronary angiography （CAG） from December 1,2008 to December 31,2012.The diagnostic performance of 320-slice CTA for detecting significant stenosis （≥ 50％ diameter） with respect to atherosclerotic plaque characteristics were analyzed by calculating sensitivity,specificity,positive predictive value （PPV）,negative predictive value （NPV）,accuracy,kappa index （κ）,and area under the receiver operating characteristic curve （AUC）.Chi-square test was used to evaluate whether there were significant differences of the true-case frequency （true positive ＋ true negative） and false-case frequency （false positive ＋ false negative） among groups.Bland-Altman analysis was used to determine limits of agreement between CTA and CAG.Results A total of 454 patients and 6 779 segments were analyzed.Diagnostic accuracy was higher in non-calcified segments; whereas they decreased in the presence of both mildmoderately and heavily calcified plaques.Excellent agreement （κ =0.810） between CT and CAG was observed for non-calcified segments,while good agreement was observed for both mild-moderately （κ =0.701） and heavily calcified segments （κ =0.750）.Both mild-moderate （P =0.000） and heavy （P =0.000） calcification decreased the true-case frequency and increased the false-case frequency when compared to non-calcification.There were no significant underestimation or overestimation for non-calcified （P =0.087） and mild-moderately calcified （P =0.704） segments,while there was significant overestimation for heavily calcified segments （P =0.001）.Conclusions Great qualitative and quantitative diagnostic performances of 320-slice CT were observed in non-calcified coronary segm
出处
《中华医学杂志》
CAS
CSCD
北大核心
2014年第39期3071-3074,共4页
National Medical Journal of China
