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目的:与CAG对照分析来评价64层螺旋CT冠状动脉成像在房颤患者中诊断有血流动力学意义的冠状动脉狭窄的准确性。方法:58例房颤患者行64层螺旋CT冠状动脉成像,扫描前均未服用倍它乐克。血管图像质量分为好、中等和差。以CAG作为参考标准,分别基于血管节段和患者水平来分析MDCTCA诊断有血流动力学意义的冠状动脉狭窄的敏感性、特异性、阳性预测价值和阴性预测价值。诊断价值的评价首先仅限于图像质量达到诊断要求的血管节段和患者,进一步的分析中将图像质量不能诊断的血管节段和患者均作为阳性来处理。结果:58例患者有645段(96.55%)图像质量为中等以上,诊断有血流动力学意义的敏感性、特异性、阳性预测价值和阴性预测价值分别是86.21%(25/29)、99.35%(612/616)、86.21%(25/29)和99.35%(612/616)。将23段图像质量没有达到诊断要求的血管均作为阳性后,CTCA诊断有血流动力学意义的血管狭窄的总体阳性预测价值为48.08%(25/52),特异性为95.77%(612/639)。基于患者总体图像质量的分析,58例患者中有47例(81.03%)图像质量为中等以上,CTCA诊断有血流动力学意义的敏感性、特异性、阳性预测价值和阴性预测价值分别是87.50%(7/8)、97.44%(38/39)、87.50%(7/8)和97.44%(38/39)。将11例图像质量没有达到诊断要求的血管均作为阳性后,CTCA诊断有血流动力学意义的血管狭窄的敏感性、特异性、阳性预测价值和阴性预测价值分别是90.00%(9/10)、79.17%(38/48)、47.37%(9/19)和97.44%(38/39)。结论:64CTCA在房颤患者中诊断有血流动力学意义的冠状动脉狭窄具有较好的阴性预测价值,但需要进一步提高图像质量来提高诊断血管狭窄的准确性。
OBJECTIVE: To evaluate the accuracy of 64-slice spiral CT coronary angiography in the diagnosis of hemodynamic coronary artery stenosis in patients with atrial fibrillation. Methods: Sixty-eight patients with atrial fibrillation underwent 64-slice spiral CT coronary angiography. None of the patients took betaxolol before the scan. Vascular image quality is divided into good, medium and poor. Using CAG as a reference standard, the sensitivity, specificity, positive predictive value and negative predictive value of MDCTCA in the diagnosis of hemodynamically significant coronary artery stenosis were analyzed based on vessel segments and patient levels, respectively. Evaluation of the diagnostic value is first limited to the segment of the blood vessel and the patient whose image quality meets the diagnostic criteria. In the further analysis, the segment of the blood vessel and the patient whose image quality can not be diagnosed are treated as positive. Results: The image quality of 645 segments (96.55%) was above average in 58 patients. The sensitivity, specificity, positive predictive value and negative predictive value of diagnosing hemodynamics were 86.21% (25/29), 99.35 % (612/616), 86.21% (25/29) and 99.35% (612/616). The overall positive predictive value of hemodynamically diagnosed vascular stenosis with CTCA was 48.08% (25/52) and specificity was 95.77% (612/639) after all 23 blood vessels that did not meet the diagnostic criteria were positive ). Based on the analysis of the overall image quality of the patients, 47 (81.03%) of the 58 patients had medium or higher image quality. The sensitivity, specificity, positive predictive value and negative predictive value of CTCA in diagnosing hemodynamics were 87.50 % (7/8), 97.44% (38/39), 87.50% (7/8) and 97.44% (38/39) respectively. The sensitivity, specificity, positive predictive value and negative predictive value of CTCA in the diagnosis of hemodynamically significant vascular stenosis were all 11 (90%) (9/10), respectively, after the 11 vessels whose image quality did not meet the diagnostic criteria were all positive. , 79.17% (38/48), 47.37% (9/19) and 97.44% (38/39) respectively. CONCLUSIONS: 64CTCA has a good negative predictive value in the diagnosis of hemodynamically significant coronary artery stenosis in patients with atrial fibrillation. However, it is necessary to further improve the image quality to improve the accuracy of diagnosis of vascular stenosis.