Jin Gong-Yong, Jeong Seul-Ki, Lee Sang-Rok, Kwon Keun-Sang, Han Young-Min, Cho Young Il
Department of Radiology, Chonbuk National University Medical School and Hospital, Research Institute of Clinical Medicine, Institute for Medical Science, Jeonju, Jeonbuk 561-712, South Korea.
J Neurol Sci. 2009 Sep 15;284(1-2):129-34. doi: 10.1016/j.jns.2009.04.036. Epub 2009 May 15.
This study was to evaluate the benefit of the screening of coronary artery stenosis (CAS) using dual-source CT (DSCT) in patients with cerebral infarction caused by a Large Artery Atherosclerosis (LAA). From November 2007 to February 2008, 34 patients (25 males and 9 females; mean age, 62.4 +/- 9.5 years) were enrolled. All of them had ischemic strokes of LAA type but with no cardiac symptoms. All patients underwent coronary CT angiography (CCTA) using DSCT. A significant coronary artery stenosis was defined as the one having more than 50% of luminal narrowing. We evaluated diagnostic accuracy for CAS in stroke patients of LAA with a receiver operating characteristics curve analysis. Of the 34 ischemic stroke patients, 18 (52.9%) had normal coronary arteries, 5 (14.7%) had insignificant CAS, and 11 (32.4%) had a significant CAS. The Agatston scores were more than 400 in 54.5% of the patients with a significant CAS, but less than 40 in 86.9% of the patients without it (p for trend = 0.001). For age, the optimal cut-off point for a diagnosis of CAS was 63, which had a sensitivity of 90.9%, a specificity of 69.6%, a positive predictive value of 58.8%, and a negative predictive value of 94.1%, respectively. For the Agatston score, the optimal cut-off was 40, which had 81.8%, 91.3%, 81.8%, and 91.3%, respectively. CCTA using DSCT appears to be a promising screening technique for CAS in patients with an ischemic stroke of LAA.
本研究旨在评估双源CT（DSCT）筛查大动脉粥样硬化（LAA）所致脑梗死患者冠状动脉狭窄（CAS）的益处。2007年11月至2008年2月，纳入34例患者（25例男性，9例女性；平均年龄62.4±9.5岁）。所有患者均为LAA型缺血性卒中，但无心脏症状。所有患者均接受了DSCT冠状动脉CT血管造影（CCTA）检查。显著冠状动脉狭窄定义为管腔狭窄超过50%。我们采用受试者工作特征曲线分析评估LAA型卒中患者CAS的诊断准确性。在34例缺血性卒中患者中，18例（52.9%）冠状动脉正常，5例（14.7%）有非显著CAS，11例（32.4%）有显著CAS。在有显著CAS的患者中，54.5%的患者阿加斯顿评分超过400，但在无显著CAS的患者中，86.9%的患者阿加斯顿评分低于40（趋势p值=0.001）。对于年龄，诊断CAS的最佳切点为63岁，其敏感性为90.9%，特异性为69.6%，阳性预测值为58.8%，阴性预测值为94.1%。对于阿加斯顿评分，最佳切点为40，其敏感性、特异性、阳性预测值和阴性预测值分别为81.8%、91.3%、81.8%和91.3%。DSCT的CCTA似乎是筛查LAA型缺血性卒中患者CAS的一种有前景的技术。
