64SSCTCA与CCA对钙化及非钙化性冠状动脉狭窄程度评估的一致性分析

目的 64排螺旋CT冠状动脉血管成像（64 SSCTCA）对钙化及非钙化性冠状动脉狭窄程度的评估与选择性X线冠状动脉成像（CCA）比较,两者进行一致性分析.方法 搜集67例患者64 SSCTCA及近期CCA资料,根据冠状动脉钙化积分的扫描结果将冠状动脉分为非钙化组和钙化组,按管径分为无狭窄、轻度狭窄（≤50%）、中度狭窄（51%-75%）和重度狭窄或闭塞（76%-100%）4个等级分别比较2组的64 SSCTCA与CCA评估狭窄程度的一致性.统计学方法采用Kappa评价方法.结果 67例患者共评价分析冠状动脉804段血管,其中非钙化组冠状动脉714段,钙化组90段;在非钙化组64SSCTCA和CCA一致性分析显示K值=0.643,二者对冠状动脉狭窄程度评估一致性好;在钙化组64 SSCTCA和CCA一致性分析显示K值=0.145,二者对冠状动脉狭窄程度评估一致性差,有55（55/90）段钙化冠状动脉血管64 SSCTCA评估狭窄程度高于CCA.结论 64 SSCTCA对非钙化冠状动脉有无狭窄及狭窄程度显示准确性高,对管壁斑块显示好;对有钙化斑块的冠状动脉狭窄评估与CCA的一致性差,64 SSCTCA常常会高估狭窄程度.

The consistency analysis of estimating the degree of stegnosis in calcification and noncalcification coronary artery by 64-slice spiral computed tomography coronary angiography and the conventional coronary angiography

Objective To evaluate the consistency of estimating the degree of stegnosis in calcification and noncalcification coronary by the 64-slice spiral computed tomography coronary angiography（64 SSCTCA） and the conventional coronary angiography （CCA）. Methods 64 SSCTCA was performed in 67 patients （37 males,30 females; mean age： 61 years） with suspected coronary artery disease, and compared with invasive coronary angiography（CCA）. The stegnosis degrees （ no stegnosis, diameter reduction ≤ 50% , 51% - 75% and 76% - 100% respectively） of vessels were identified by 64 SSCTCA and CCA. All the vessels were divided into two groups （calcification group, noncalcification group ） according to the results of CT scan. The consistency of stegnosis degree was compared between two methods in calcification group and nonealcification group. The results were analyzed according to Kappa value. Results Among 67 patients, 804 segments could be evaluated. There were 90 and 714 segments in calcification group and noncalcification group respectively. The consistency coefficient Kappa（K） was 0. 145 and O. 643 in the two groups respectively. Conclusion As compared with CCA, the 64 SSCTCA has high quantitative and qualitative diagnostic accuracy for noncalcification coronary artery. In Calcification coronary artery, the consistency of estimating the degree of stegnosis between 64 SSCTCA and CCA is worse, and 64 SSCTCA often overestimates the degree of stegnosis.