王俊人,孙玉,李晓岗,邹明宇,杨本强.对比单次屏气与两次屏气法减影冠状动脉CT血管造影评估严重钙化冠状动脉狭窄[J].中国医学影像技术,2022,38(7):1081~1085
对比单次屏气与两次屏气法减影冠状动脉CT血管造影评估严重钙化冠状动脉狭窄
Comparison on single and two times breath-holding subtraction coronary CT angiography for evaluating severe calcified coronary artery stenosis
投稿时间:2022-03-08  修订日期:2022-05-23
DOI:10.13929/j.issn.1003-3289.2022.07.027
中文关键词:  冠状动脉疾病  冠状动脉造影  质量控制  减影技术  钙质沉着症
英文关键词:coronary artery disease  coronary angiography  quality control  subtraction technique  calcinosis
基金项目: 辽宁省科学技术计划(2018225024)。
作者单位E-mail
王俊人 锦州医科大学中国人民解放军北部战区总医院研究生培养基地, 辽宁 沈阳 110016  
孙玉 中国人民解放军北部战区总医院放射科, 辽宁 沈阳 110016  
李晓岗 中国人民解放军北部战区总医院放射科, 辽宁 沈阳 110016  
邹明宇 中国人民解放军北部战区总医院放射科, 辽宁 沈阳 110016  
杨本强 中国人民解放军北部战区总医院放射科, 辽宁 沈阳 110016 bqyang888@sina.com 
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中文摘要:
       目的 对比分析单次屏气与两次屏气方法获得减影冠状动脉CT血管造影(sub-CCTA)对评估严重钙化(Agatston钙化积分>400)冠状动脉狭窄的价值。方法 回顾性分析60例疑诊冠心病患者CCTA及侵入性冠状动脉造影(ICA)资料,根据扫描方法分为单次屏气组(n=32)及两次屏气组(n=28)。针对CCTA显示严重钙化节段,对比2组常规CCTA(con-CCTA)和sub-CCTA图像质量评分;以ICA结果为标准,绘制受试者工作特征(ROC)曲线,计算曲线下面积(AUC),评估CCTA诊断目标节段狭窄率≥50%的效能。结果 单次屏气组中,CCTA共检出134个冠状动脉节段存在严重钙化,其中78个节段ICA显示狭窄率≥50%;con-CCTA图像质量评分为3.0(2.0,3.0),低于sub-CCTA 。两次屏气组中,CCTA共检出127个冠状动脉节段存在严重钙化,其中74个节段ICA显示狭窄率≥50%;con-CCTA图像质量评分为3.0(2.0,3.0),低于sub-CCTA 。con-CCTA评估单次、两次屏气组目标节段狭窄率≥50%的AUC(0.780、0.767)均低于sub-CCTA(AUC=0.903、0.898,Z=4.198、3.470,P均<0.010)。单次屏气sub-CCTA图像质量评分高于两次屏气sub-CCTA(Z=-2.954,P=0.030),而诊断目标节段狭窄率≥50%的准确率差异无统计学意义(Z=0.129,P=0.900)。结论 单次与两次屏气法sub-CCTA评估严重钙化冠状动脉节段狭窄程度效能相仿,但前者图像质量更佳。
英文摘要:
      Objective To observe the value of subtraction coronary CT angiography (sub-CCTA) obtained with single and two times breath-holding for evaluating severe calcified coronary stenosis (Agatston calcification score>400). Methods Data of CCTA and invasive coronary angiography (ICA) of 60 patients with suspected coronary artery disease were retrospectively analyzed. The patients were divided into single (n=32) and two times breath-holding group (n=28) according to the method of single or two times breath-holding during scanning. Coronary segments with CCTA showed severe calcifications were analyzed, and the image quality scores of conventional CCTA (con-CCTA) and sub-CCTA were compared. Taken ICA results as golden standards, receiver operating characteristic (ROC) curve was drawn, and the area under the curve (AUC) was calculated to assess the efficacy of CCTA for diagnosing target segments stenosis rate ≥50%. Results In single breath-holding group, 134 coronary segments were found with severe calcification using CCTA, including 78 segments showed stenosis rate ≥50% evaluated with ICA, the image quality score of con-CCTA was 3.0 (2.0, 3.0), lower than those of sub-CCTA (3.0, Z=-7.037, P<0.010). In two times breath-holding group, 127 coronary segments were found with severe calcification using CCTA, including 74 segments with stenosis rate ≥50% evaluated with ICA, the image quality score of con-CCTA was 3.0 (2.0, 3.0), lower than those of sub-CCTA (3.0, Z=-5.011, P<0.010). AUC of con-CCTA in single (0.780) and two times breath-holding group (0.767) for assessing coronary target segment stenosis rate ≥50% was lower than those of sub-CCTA (AUC=0.903, 0.898, Z=4.198, 3.470, both P<0.010). The image quality score of single breath-holding sub-CCTA was higher than that of two times breath-holding sub-CCTA (Z=-2.954, P=0.030), while there was no significant difference of the accuracy of diagnosing target segment stenosis rate ≥50% between groups (Z=0.129, P=0.900). Conclusion The diagnostic efficacy of single and two times breath-holding sub-CCTA for assessing severe calcification coronary segment stenosis was similar, but the former had better image quality.
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