摘要
目的评估双源CT(DSCT)显示冠状动脉侧支循环(CCC)的能力。方法回顾性分析2013年1月至2014年12月在本院行冠状动脉CTA检查图像质量良好、并且在4周内经冠状动脉造影(CAG)检查证实至少有一处冠状动脉主要分支闭塞患者资料。以CAG为金标准评估双源CT冠状动脉血管成像(CTA)发现侧支循环的敏感度和特异度,并且以Rentrop分级法为标准评价CTA误诊和漏诊的情况。在CAG图像上按照Rentrop分级法评估冠状动脉侧支循环情况,在DSCT图像上按照新的冠状动脉分级方法评价,应用Kappa系数检验评估这两种分级标准的一致性。结果共有125例患者入组,其中69例患者CAG影像上发现至少1处CCC。以CAG为金标准,双源CTA发现CCC患者的敏感度为73.9%,特异度为87.5%;发现CCC血管的敏感度为80.7%。将CAG和CTA诊断的CCC按照各自标准分级,两种分级标准间存在较高的一致性(K=0.608,P=0.000)。CTA漏诊的17处病变中,包括13处Rentrop 1级、1处Rentrop 2级和3处Rentrop 3级。误诊的6处中,有3处被误诊断为Rentrop 1级、3处被误诊断为Rentrop 2级。结论尽管对部分侧支循环及小的血管显示欠佳,但在冠状动脉血管闭塞患者中CTA依然能准确发现侧支循环。
Objective To evaluate the ability of dual-source CT in demonstrating the coronary collateral circulation（CCC）. Methods Patients who underwent both coronary CTA and CAG within 4 weeks which demonstrated a total coronary occlusion（TIMI grade 0） in one of the major coronary arteries between January 2013 and December 2014 were entered into the study. CTA was performed using a dual-source CT. Taking traditional CAG as the reference standard,we evaluated the sensitivity and specificity of CTA in demonstrating coronary collateral circulation,and analyzed the misdiagnosis and missed diagnosis of CTA according to the Rentrop grading. The CCCs were assessed in CAG by the Rentrop grading in CAG and a new grading in the DSCT coronary angiography imaging. The consistency between these two grading standards was analyzed by Kappa test. Results A total of 125 patients were enrolled into the study,among whom at least one CCC was found by CAG in 69 patients. Taking the CAG results as the reference standard,the sensitivity and specificity of the DSCT angiography in detecting patients with the CCC were 73. 9% and 87. 5% respectively. The sensitivity of detecting CCC using DSCT angiography was 80. 7%. All the CCC detected by CAG and DSCT angiography were grouped by different criteria. The consistency of the two grading criteria was relatively high（Kappa = 0. 608,P = 0. 000）. The 17 missed diagnoses included13 cases of Rentrop-1,1case of Rentrop-2,and 3 cases of Rentrop-3. The 6 misdiagnosis included 3 cases of Rentrop-1 and3 of Rentrop-2. Conclusion DSCT angiography can accurately detect the presence of any coronary collateralization in patients with total occlusions,although currently limitations in the assessment of individual collaterals and smaller vessels by applying CT technology.
出处
《临床放射学杂志》
CSCD
北大核心
2017年第11期1612-1617,共6页
Journal of Clinical Radiology
关键词
侧支循环
体层摄影术
X线计算机
冠心病
Collateral circulation
Tomography,X-ray computed
Coronary artery disease
