【摘要】 目的以血管内超声(IVUS)为标准,评价双源螺旋CT(DSCT)对冠状动脉斑块、血管重塑的临床应用价值。方法入选拟诊为冠心病的17例患者,分别行DSCT和IVUS检查,以10mm为一评估节段,分别评估每个有效节段斑块的性质和CT值,并测定管腔面积、斑块面积、斑块负荷和血管重塑指数。结果在21支冠状动脉的114段可评估的冠状动脉节段中,DSCT对斑块诊断的敏感性为88.10%(37/42),特异性为95.83%(69/72),阳性预测值为92.50%(37/40),阴性预测值为93.2%(69/74)。DSCT和IVUS对管腔面积、斑块面积和斑块负荷的测量值分别为:(6.79±3.29)mm~2比(6.80±2.79)mm~2;(8.89±5.44)mm~2比(8.24±3.05)mm~2;(55.26±13.32)%比(55.09±9.42)%(P>0.05)。相关系数分别为0.81,0.75和0.51(P<0.01)。以IVUS结果将斑块分为脂质斑块、纤维斑块和钙化斑块,分别测得CT值为(54.50±5.59)HU(117.90±13.79),HU(780.18±134.73)HU(P<0.01)。两两比较发现脂质斑块和纤维斑块的CT值无显著性差异(P=0.44)。DSCT与IVUS对血管重塑指数相关性检验,r=0.38,P<0.05。结论与IVUS比较,DSCT是一种能有效检测冠状动脉粥样斑块的无创检查方法,能准确的评估冠脉临界病变的管腔面积、斑块面积及斑块负荷,能有效评估冠状动脉钙化和非钙化成分,对血管重塑性的评估与IVUS测量结果相关。更多还原

【Abstract】 Objective To evaluate the detection and quantification of coronary atherosclerotic plaques and to explore arterial remodeling by dual-source computed tomography (DSCT) in comparison with intravascular ultrasound (IVUS). Methods Seventeen patients with suspected coronary atherosclerotic disease were examined using contrast-enhanced DSCT and IVUS. The coronary arteries were divided into 10-mm segments. The CT density, coronary luminal surface area, plaque area, plaque burden and remodeling index were measured in each segment and compared with the IVUS images. Results In 21 coronary arteries, 114/123 segments were analyzed on both DSCT and IVUS. Compared with IVUS, the sensitivity, specificity, positive predictive value and negative predictive value for the detection of plaques by DSCT were 88.10%, 95.83%, 92.50%, and 93.20%, respectively. Coronary luminal surface area, plaque area and plaque burden detected on DSCT (6.79±3.29 mm2, 8.89±5.44 mm2, 55.26±13.32%) were not significantly (P>0.05) different from those on IVUS (6.80±2.79 mm~2, 8.24±3.05 mm~2, 55.09±9.42%) with significant (P<0.01) correlation coefficients of 0.81,0.75 and 0.51 respectively. The CT densities of soft (54.50±5.59, range: 42.19-66.81 HU) and fibrous (117.90±13.79 HU, range: 89.14-146.67 HU) plaques were significantly (P<0.01) lower than those of calcified plaques (780.18±134.73 HU, range: 479.98-1080.38 HU) whereas the difference between the soft and fibrous plaques was not significant (P=0.44). The correlation coefficient of remodeling index between DSCT and IVUS was 0.38 (P<0.05). Conclusion Compared with IVUS, DSCT correlates well with IVUS for the detection and quantification of coronary atherosclerotic plaques as well as measurements of arterial remodeling. However, the accuracy of DSCT for identifying non-calcified plaque is low.更多还原