【摘要】 目的 探讨双源CT冠状动脉CT血管造影(CCTA)对冠状动脉钙化斑块管腔狭窄的诊断价值。方法 894例怀疑冠状动脉病变患者行双源CT CCTA和冠状动脉造影(CAG)检查。在CCTA图像上，根据冠状动脉管腔横断面钙化斑块区域占管腔周长比率分为4种类型(Ⅰ～Ⅳ型)。以CAG作为金标准，评价CCTA对各种类型钙化斑块管腔狭窄诊断准确性。结果 CCTA对Ⅰ型和Ⅱ型钙化斑块管腔狭窄诊断具有较高的敏感度(96.7%、98.1%)、特异度(99.8%、97.0%)、阳性预测值(95.7%,90.1%)、阴性预测值(99.8%,99.5%)和准确率(99.6%、97.3%); CCTA对Ⅲ型和Ⅳ型钙化斑块管腔狭窄诊断敏感度(Ⅲ型97.6%、Ⅳ型97.9%)和阴性预测值(Ⅲ型98.3%、Ⅳ型98.7%)较高，而特异度(Ⅲ型78.7%、Ⅳ型67.9%)、阳性预测值(Ⅲ型71.0%、Ⅳ型56.2%)及准确率(Ⅲ型84.9%、Ⅳ型76.8%)明显降低。结论 CCTA对Ⅰ型和Ⅱ型钙化斑块管腔狭窄诊断准确率最高，对Ⅲ型和Ⅳ型钙化斑块管腔狭窄诊断特异度和阳性预测值明显降低。更多还原

【Abstract】 Objective To investigate the diagnostic value of coronary CT angiography(CCTA) with dual-source CT for the assessment of coronary stenosis due to calcified plaque.Methods 894 patients with suspected coronary artery disease underwent CCTA using dual-source CT and conventional coronary angiography(CAG). In CCTA images, the calcified plaques were classified into four types(Ⅰ-Ⅳ) according to the ratio of calcified plaque area to vessel circumference. Diagnostic accuracy of CCTA for various types of calcified plaques was evaluated by using CAG as a standard reference.Results CCTA had high diagnostic performance in sensitivity(96.7%,98.1%), specificity(99.8%,97.0%), PPV(95.7%,90.1%),NPV(99.8%,99.5%) and accuracy(99.6%,97.3 %) for type Ⅰ-Ⅱ calcification, CCTA had high performance in sensitivity(97.6%,97.9%) and NPV(98.3%,98.7%) for type Ⅲ-Ⅳ calcification, while remarkable decrease in specificity(78.7%,67.9%), PPV(71.0%,56.2%) and accuracy(84.9%,76.8%).Conclusion CCTA has highest accuracy in diagnosing the coronary artery stenosis of type Ⅰ-Ⅱ calcified plaques, but has a significant decrease in specificity, PPV and accuracy in type Ⅲ-Ⅳ calcified plaques.更多还原