双源冠状动脉CTA对冠状动脉粥样硬化斑块评估的研究价值

The Research Value of Dual-Source Coronary CTA in the Assessment of Coronary Atherosclerotic Plaques

摘要: 目的：双源CT (dual-source CT, DSCT)具有成像速度快、分辨率高、辐射剂量低、扫描速度快，受心率、心律及呼吸的影响小、无需心率控制等优势，可评估冠状动脉狭窄程度、斑块性质。本研究目的为探究DSCT在冠状动脉粥样硬化斑块评估中的应用价值。方法：选取80例因胸痛、胸闷等疑似冠状动脉疾病症状就诊，或存在高血压、高血脂、糖尿病等心血管危险因素，需进一步明确冠状动脉情况的患者作为研究对象。分别对研究对象进行双源CT (DSCT)及血管内超声(IVUS)检查评估冠状动脉粥样硬化斑块分布、类型和性质。结果：DSCT对临界病变检出率65%，IVUS对临界病变检出率67%，采用卡方检验(χ²检验)比较两者差异，P > 0.05，提示DSCT与IVUS在斑块检出率上无显著差异；斑块性质判断：对比DSCT与IVUS对钙化斑块、非钙化斑块、混合斑块的分类一致性，Kappa值 = 0.852表示一致性良好。结论：经双源 CT冠状动脉成像技术诊断，临床医师可以综合了解冠心病患者粥样硬化斑块的密度、分布状况、冠状动脉重构状况，便于冠心病准确分型诊断，对临床具有指导作用。

Abstract: Objective: Dual-source CT (DSCT) has the advantages of fast imaging speed, high resolution, low radiation dose, rapid scanning speed, little influence from heart rate, cardiac rhythm and respiration, and no need for heart rate control. It can assess the degree of coronary artery stenosis and the nature of plaques. The purpose of this study is to explore the application value of DSCT in the assessment of coronary atherosclerotic plaques. Methods: Eighty patients who presented with symptoms suspected of coronary artery diseases such as chest pain and chest tightness, or those with cardiovascular risk factors such as hypertension, hyperlipidemia and diabetes mellitus and in need of further clarification of the coronary artery condition were selected as the research subjects. The research subjects were respectively examined by dual-source CT (DSCT) and intravascular ultrasound (IVUS) to assess the distribution, type and nature of coronary atherosclerotic plaques. Results: The detection rate of DSCT for critical lesions is 65%, and the detection rate of IVUS for critical lesions is 67%. The chi-square test (χ² test) was used to compare the differences between the two, and P > 0.05, indicating that there was no significant difference in the plaque detection rate between DSCT and IVUS; Judgment of plaque nature: By comparing the classification consistency of DSCT and IVUS for calcified plaques, non-calcified plaques and mixed plaques, the Kappa value = 0.852, indicating good consistency. Conclusion: Through the dual-source CT coronary artery imaging technology for diagnosis, clinicians can comprehensively understand the density, distribution status of atherosclerotic plaques and the reconstruction status of coronary arteries in patients with coronary heart disease, which is convenient for accurate classification and diagnosis of coronary heart disease and has guiding significance for clinical practice.