校正的管腔内对比度衰减梯度对冠状动脉功能性狭窄诊断价值的初步研究

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摘要目的：以血流储备分数（FFR）为“金标准”，比较校正的管腔内对比度衰减梯度（TAG with corrected contrast opacification，TAG-CCO）与管腔内对比度衰减梯度（Transluminal contrast attenuation gradient，TAG）在诊断冠状动脉功能性狭窄上的差异。探讨TAG联合冠状动脉CTA（CCTA）及TAG-CCO联合CCTA诊断功能性狭窄的应用价值。方法：回顾性分析冠状动脉狭窄患者18例，26支血管。各患者均做CCTA、冠状动脉造影检查及FFR测定，测量TAG及TAG-CCO值。以血管为单位，将FFR≤0.80作为诊断功能性狭窄的标准，分为功能性狭窄组和无功能性狭窄组，比较组间TAG及TAG-CCO值有无差异。计算TAG、TAG-CCO的敏感度、特异度及准确率，探讨TAG-CCO联合CCTA能否增加判定功能性狭窄的敏感度及特异度。结果：功能性狭窄组与无功能性狭窄组TAG及TAG-CCO无统计学差异（P=0.893 vs P=0.683）。TAG、TAG-CCO的敏感度、特异度、阳性预测值、阴性预测值及准确率分别为77.8%、41.2%、41.2%、77.8%和53.9%；77.8%、29.4%、36.8%、71.4%和46.2%。CCTA、TAG联合CCTA、TAG-CCO联合CCTA的ROC曲线下面积分别为0.657、0.693、0.670，三者间无显著差异（P＞0.05）。结论：基于CCTA的TAG及TAG-CCO尚不能较好预测功能性狭窄。TAG或TAG-CCO联合CCTA不能明显改善功能性狭窄的判定。

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	王玉科
	侯阳
	马跃

关键词 ：冠状动脉狭窄, 体层摄影术, X线计算机

Abstract：Objective: To compare the difference of transluminal contrast attenuation gradient(TAG), TAG with corrected contrast opacification(TAG-CCO) using fractional flow reserve(FFR) as the gold standard, to evaluate the application value of TAG combined with coronary CTA(CCTA) and TAG-CCO combined with CCTA in the diagnosis of functional stenosis of coronary artery. Methods: We measured TAG and TAG-CCO of 26 major epicardial coronary arteries from 18 patients who underwent CCTA and followed by invasive coronary angiography and FFR. Diagnostic performance of TAG and TAG-CCO was assessed using FFR≤0.80 as the reference standard. Results: TAG and TAG-CCO were not statistically significant between functional stenosis group and non functional stenosis group(P=0.893 vs P=0.683). The sensitivity, specificity, positive, negative predictive values and accuracy of TAG and TAG-CCO for FFR≤0.80 were 77.8% vs 77.8%, 41.2% vs 29.4%, 41.2% vs 36.8%, 77.8% vs 71.4% and 53.9% vs 46.2%, respectively. The area under the ROC curve of CCTA, TAG combined with CCTA and TAG-CCO combined with CCTA were 0.657, 0.693 and 0.670, and there was no significant difference among the three(P>0.05). Conclusion: The value of TAG or TAG-CCO in evaluating hemodynamically significant stenosis by CCTA seems to be limited. TAG or TAG-CCO combined with CCTA can not improve the diagnosis of ischemia-causing coronary stenosis.

Key words： Coronary stenosis Tomography, X-ray computed

收稿日期: 2016-03-01

PACS:
	Ｒ543.3
	Ｒ814.42

基金资助:国家自然科学基金（81301221）；2014年辽宁省高等学校创新团队（LT2014017）。

通讯作者: 侯阳，中国医科大学附属盛京医院放射科，110004。E-mail：houyang1973@163.com

引用本文:

王玉科，侯阳，马跃. 校正的管腔内对比度衰减梯度对冠状动脉功能性狭窄诊断价值的初步研究[J]. 中国临床医学影像杂志, 2016, 27(10): 713-717.
WANG Yu-ke, HOU Yang, MA Yue. Diagnostic value of corrected transluminal contrast attenuation gradient in coronary computed tomography angiography for the evaluation of physiologically significant coronary artery stenosis. JOURNAL OF CHINA MEDICAL IMAGING, 2016, 27(10): 713-717.

链接本文:

http://www.jccmi.com.cn/CN/ 或 http://www.jccmi.com.cn/CN/Y2016/V27/I10/713

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