【作者】 徐飞；

【导师】 胡申江；

【作者基本信息】 浙江大学 ， 心血管内科， 2011， 硕士

【摘要】 目的以选择性冠状动脉造影(CAG)结果为金标准,观察64排双源CT冠状动脉血管成像(CTA)对于冠状动脉狭窄的诊断价值。方法2010年3月至2011年3月于浙江大学医学院附属第一医院住院30名可疑冠状动脉粥样硬化性心脏病患者,接受双源CTA及冠状动脉造影检查。以冠状动脉造影结果为参考标准,评估64排双源CTA诊断冠状动脉狭窄的敏感性、特异性、准确性、阳性预测值和阴性预测值等。结果30例患者最终可供分析冠状动脉段共412段。其中冠状动脉造影CAG和双源CTA共同检出狭窄阳性118段,仅冠状动脉造影检出狭窄17段,仅双源CTA检出狭窄9段,两者均未检出狭窄268段。对比CAG结果,双源CTA诊断冠状动脉狭窄敏感性为87.4%,且血管狭窄程度越重,敏感性越高；特异性为96.8%；准确性为93.7%；总阳性预测值为92.9%,且血管狭窄程度越重,阳性预测值越高,中、重度狭窄时阳性预测值达100%；阴性预测值为94.0%。在对冠状动脉三支主要血管狭窄判定中,双源CTA对冠状动脉左主干及前降支狭窄诊断敏感性(92.9%)、特异性(100%)、阳性预测值(100%)、阴性预测值均(96.3%)均最高,诊断左回旋支狭窄敏感性(75%)、阳性预测值(78.3%)最低,且与其他分支血管敏感性及阳性预测值差异明显。结论双源CT冠状动脉血管成像对于冠状动脉狭窄诊断的敏感性、特异性、准确性、阳性预测值、阴性预测值均较高,诊断价值接近于冠状动脉造影。更多还原

【Abstract】 Purpose. To determine the clinic value of Dual-source CT selective coronary angiography (CTA) in the detection of coronary artery stenosis compared to coronary angiography (CAG), the golden standard test.Materials and methods. Thirty patients with suspected Coronary heart disease (CHD) in the ward of The First Affiliated Hospital of Medical School of Zhejiang University underwent both Dual-source CT coronary angiography (CTA) and selective coronary angiography (CAG).The results of CAG was performed as a reference standard.Results.412 segments of the coronary arteries of 30 patients were taken to the study. 118 stenotic segments were found both by CTA and CAG,17 were found by CAG only, 9 were found by CTA only, and 268 were showed stenosis by neither CTA nor CAG. The diagnostic sensitivity of dual-source CTA was 87.4%, and the more serious the stenosis was, the higher the sensitivity was. The specificity was 96.8%. The total positive predictive value was 92.9%, and the more serious the stenosis was, the higher the positive predictive value was. The negative predictive value was 94.0%. The accuracy was 93.7%. The diagnostic sensitivity(92.9%), specificity(100%), positive predictive value(100%) and negative predictive value(96.3%) of the left main coronary artery and the left anterior descending branch are the highest during all three main branches of the coronary artery. The diagnostic sensitivity(75%) and the positive predictive value(78.3%) of the left circumflex, are the lowest during all the branches, and differ significantly.Conclusion. Dual-source CT coronary angiography has a high level of diagnosticsensitivity, specificity, positive predictive value, negative predictive value in the detection of coronary heart disease. The diagnostic value of dual-source CT is close to that of coronary angiography.更多还原