采用 64 层螺旋 CT 对非阻塞性左主干冠状动脉斑块进行定量和定性评估，并与血管内超声比较。

Quantitative and qualitative assessment of non-obstructive left main coronary artery plaques using 64-multislice computed tomography compared with intravascular ultrasound.

机构信息

Department of Internal Medicine, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, Shanghai 200032, China.

出版信息

Chin Med J (Engl). 2010 Apr 5;123(7):827-33.

PMID:20497672

Abstract

BACKGROUND

There are few reports of quantitative and qualitative measuring of left main coronary artery (LMCA) plaques by multislice computed tomography coronary angiography (MSCTA), especially when compared with intravascular ultrasound (IVUS) as reference standard. The aim of this study was to evaluate the use of 64-MSCTA in the diagnosis of LMCA disease, and the accuracy of MSCTA in the quantitative and qualitative assessment of the LMCA lesion as compared with IVUS.

METHODS

A total of 91 patients (53 men, 38 women, mean age (64.78 +/- 9.19) years) were examined by 64-MSCTA and IVUS. Compared with the IVUS, the sensitivity, specificity, positive and negative predictive values (PPV and NPV) of the MSCTA on the diagnosis of LMCA diseases were calculated. Also, kappa index (kappa) for the agreement between MSCTA and IVUS was calculated. Minimal lumen area (MLA), external elastic membrane cross-sectional area (EEM-CSA) and plaque burden were measured by two blinded and independent operators on MSCTA cross-sectional reconstruction and compared with the parameters measured from IVUS by manually tracing. The CT value of soft, fibrous and calcific plaques was measured using IVUS classification of the plaques.

RESULTS

The sensitivity, specificity, PPV and NPV of MSCTA for detecting LMCA plaques were 93.1%, 84.2%, 95.7%, 76.2%, respectively. Kappa index (kappa = 0.744, P < 0.001) indicated excellent agreement between MSCTA and IVUS. The Pearson index between MLA on IVUS and MLA on MSCTA was 0.815 (P < 0.01). The Pearson index of plaque burden and EEM-CSA between IVUS and MSCTA was 0.736 and 0.740 respectively (both P < 0.01). The CT value of soft plaque, fibrous plaque and calcific plaque compared with IVUS were (52.52 +/- 15.71) HU, (108.32 +/- 43.44) HU and (604.16 +/- 377.67) HU (P < 0.001). Receiver operating characteristic curve analysis of CT value of non-calcific plaques for predicting soft plaques showed the cutpoint was 54.35 HU, with a sensitivity of 83.3% and specificity of 94.4%.

CONCLUSIONS

Sixty-four section MSCTA is an effective diagnostic tool for the detection of LMCA plaques with higher sensitivity and specificity. The correlation of quantitative and qualitative analysis between MSCTA and IVUS was excellent. The CT value of plaques can help the diagnosis of plaque composition.

摘要

背景

多层螺旋 CT 冠状动脉造影（MSCTA）定量和定性测量左主干冠状动脉（LMCA）斑块的报道较少，尤其是与血管内超声（IVUS）作为参考标准相比。本研究旨在评估 64-MSCTA 在 LMCA 疾病诊断中的应用，并比较 MSCTA 对 LMCA 病变的定量和定性评估与 IVUS 的准确性。

方法

共对 91 例患者（男 53 例，女 38 例，平均年龄（64.78±9.19）岁）进行 64-MSCTA 和 IVUS 检查。与 IVUS 相比，计算 MSCTA 对 LMCA 疾病诊断的灵敏度、特异度、阳性预测值（PPV）和阴性预测值（NPV）。同时，计算 MSCTA 与 IVUS 之间的一致性的kappa 指数（kappa）。在 MSCTA 横截面重建上，由两名独立的、盲法的操作人员测量最小管腔面积（MLA）、外弹力膜横截面积（EEM-CSA）和斑块负荷，并与 IVUS 手动追踪测量的参数进行比较。使用 IVUS 斑块分类测量软斑块、纤维斑块和钙化斑块的 CT 值。

结果

MSCTA 检测 LMCA 斑块的灵敏度、特异度、PPV 和 NPV 分别为 93.1%、84.2%、95.7%、76.2%。kappa 指数（kappa=0.744，P<0.001）表明 MSCTA 与 IVUS 之间具有良好的一致性。IVUS 上的 MLA 与 MSCTA 上的 MLA 之间的 Pearson 指数为 0.815（P<0.01）。IVUS 与 MSCTA 之间的斑块负荷和 EEM-CSA 的 Pearson 指数分别为 0.736 和 0.740（均 P<0.01）。与 IVUS 相比，软斑块、纤维斑块和钙化斑块的 CT 值分别为（52.52±15.71）HU、（108.32±43.44）HU 和（604.16±377.67）HU（P<0.001）。非钙化斑块 CT 值预测软斑块的受试者工作特征曲线分析显示，截断点为 54.35 HU，灵敏度为 83.3%，特异性为 94.4%。