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目的:对比血管内超声(IVUS),评价多排螺旋CT(MSCT)判断冠状动脉粥样硬化斑块特征的精确性。方法:连续性入选2007-08-2008-12期间在解放军总医院心内科诊断为冠心病并行MSCT、IVUS检查者,分别利用IVUS、MSCT方法测量同一病变的同一截面的血管截面积(V-CSA)、管腔截面积(L-CSA)、狭窄程度、斑块负荷(BP)、重构指数(RI)等指标;对比IVUS,计算MSCT判断狭窄程度及斑块性质的敏感性、特异性、阳性预测值(PPV)、阴性预测值(NPV)。结果:与IVUS对比,MSCT显示冠状动脉粥样硬化斑块的敏感性为98.0%,特异性为90.1%,PPV为93.0%,NPV为97.0%;显示狭窄程度>50.0%病变的敏感性为96.5%,特异性为97.1%,PPV为98.2%,NPV为94.3%;MSCT与IVUS测量冠状动脉同一病变同一截面下的V-CSA、L-CSA、BP及RI,各指标之间存在明显直线相关关系;MSCT判断脂质斑块的敏感性为88.9%,特异性为84.9%;纤维斑块的敏感性为73.3%,特异性为91.2%;钙化斑块的敏感性为95.7%,特异性为100%。结论:MSCT在诊断冠心病、判断冠状动脉粥样硬化斑块特征方面有较好的精确性,可做为无创性评估易损斑块的手段。
OBJECTIVE: To compare the accuracy of multislice spiral CT (MSCT) in determining coronary atherosclerotic plaque by comparing intravascular ultrasound (IVUS). Methods: The patients who were diagnosed as coronary heart disease concurrently with MSCT and IVUS during the period of 2007-08-2008-12 were enrolled in the Department of Cardiology of People’s Liberation Army General Hospital. Vascular cross-sectional area (V-CSA) of the same section of the same lesion was measured by IVUS and MSCT respectively ), Lumen cross-sectional area (L-CSA), stenosis degree, plaque burden (BP) and remodeling index (RI) were calculated.Compared with IVUS, MSCT was used to determine the sensitivity and specificity of stenosis and plaque. Positive predictive value (PPV), negative predictive value (NPV). Results: Compared with IVUS, MSCT showed a sensitivity of 98.0%, a specificity of 90.1%, a PPV of 93.0% and a NPV of 97.0%. MSCT showed a sensitivity of 96.5 for stenosis> 50.0% of lesions %, The specificity was 97.1%, the PPV was 98.2% and the NPV was 94.3%. There was a significant linear correlation between MSCT and IVUS in measuring the same cross-section of coronary artery in the same section of V-CSA, L-CSA, BP and RI The sensitivity and specificity of MSCT were 88.9% and 84.9% respectively. The sensitivity and specificity of fibrous plaque were 73.3% and 91.2% respectively. The sensitivity of calcified plaque was 95.7% and the specificity was 100%. Conclusion: MSCT has good accuracy in diagnosing coronary heart disease and judging the features of coronary atherosclerotic plaque. It can be used as a noninvasive means to evaluate vulnerable plaque.