Effect of calcified plaque load on the accuracy of coronary CT angiography in the diagnosis of lumen stenosis
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摘要:
目的 探究斑块钙化负荷对冠状动脉CT血管造影（CCTA）诊断管腔狭窄准确性的影响。 方法 选取上海市嘉定区中心医院放射科于2019年2月~2022年1月收治的100例患者作为研究对象，所有患者均行冠状动脉造影与CCTA检查，钙化容积与钙化积分以血管段为单位进行记录，按照钙化容积与钙化积分不同将患者分为4组，分析各组血管管腔狭窄程度并探究CCTA判断斑块钙化不同容积与积分的管腔狭窄准确性。 结果 100例患者中入选的钙化冠状动脉段共396个，按照15段进行计算，以管腔狭窄≥50%为有意义狭窄，得到敏感度、特异性、准确率、阳性预测值与阴性预测值分别为99.03%（204/206）、83.16%（158/ 190）、91.41%（362/396）、86.44%（204/236）、98.75%（158/160）；当钙化容积≤25 mm2、钙化积分≤80分时，敏感度、特异性、准确率、阳性预测值、阴性预测值均为100%；当196 mm2<钙化容积≤1375 mm2时，敏感度、特异性、准确率、阳性预测值、阴性预测值分别为85.71%、36.36%、75.47%、83.72%、40.00%；当钙化积分>200分时，敏感度、特异性、准确率、阳性预测值、阴性预测值分别为92.86%、75.00%、87.50%、89.66%、91.82%；CCTA诊断不同钙化容积管腔狭窄程度与不同钙化积分管腔狭窄程度的敏感度、特异性、准确率、阳性预测值、阴性预测值具有统计学意义（P<0.05），其中诊断0~25 mm2钙化容积管腔狭窄程度与0~80分钙化积分管腔狭窄程度的敏感度、特异性、准确率、阳性预测值、阴性预测值最高。 结论 不同斑块钙化负荷对CCTA诊断管腔狭窄程度准确性的影响存在差异，应引起临床重视。 Abstract:Objective To investigate the influence of calcified plaque burden on the accuracy of coronary CT angiography (CCTA) in the diagnosis of lumen stenosis. Methods A total of 100 patients who underwent coronary angiography (CAG) and CCTA in the Department of Radiology at Shanghai Jiading District Central Hospital from February 2019 to January 2022 were selected as the research subjects. The calcification volume and calcification score were recorded in vascular segments. The patients were divided into four groups according to the calcification volume and calcification score, and the degree of vascular stenosis in each group was analyzed. The accuracy of CCTA in diagnosing lumen stenoses of different plaque calcification volume and scores was discussed. Results A total of 396 calcified coronary artery segments were selected from the 100 patients. Based on 15 segments, lumen stenosis ≥50% indicated significant stenosis. The sensitivity, specificity, accuracy, positive predictive value and negative predictive value were 99.03% (204/206), 83.16% (158/190), 91.41% (362/396), 86.44% (204/ 236) and 98.75% (158/160), respectively. Under the condition of calcification volume ≤25 mm2 and calcification score≤80 points, the sensitivity, specificity, accuracy, positive predictive value and negative predictive value all were 100%. Under the condition of 196 mm2<calcification volume≤1375 mm2, the sensitivity, specificity, accuracy, positive predictive value and negative predictive value were 85.71%, 36.36%, 75.47%, 83.72% and 40.00%, respectively. When the calcification score was higher than 200, the sensitivity, specificity, accuracy, positive predictive value and negative predictive value were 92.86%, 75.00%, 87.50%, 89.66% and 91.82%, respectively. The sensitivity, specificity, accuracy, positive predictive values and negative predictive values of CCTA to diagnose lumen stenosis of different calcification volumes and different calcification scores were significantly different (P<0.05). The sensitivity, specificity, accuracy, positive predictive value and negative predictive value were the highest to diagnose lumen stenosis of 0-25 mm2 calcification volume and 0-80 calcification score. Conclusion Different calcified plaque loads have different influence on the accuracy of CCTA in the diagnosis of lumen stenosis, which deserves attention in clinical practice. -
Key words:
- coronary CT angiography /
- coronary angiography /
- calcification load /
- coronary stenosis /
- accuracy
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图 1 CCTA曲面重建右冠状动脉多发钙化灶
Figure 1. Multiple calcification of right coronary artery on the curve planar reformation image of CCTA.
表 1 CCTA对不同钙化容积管腔狭窄程度的准确性
Table 1. Accuracy of CCTAin diagnosing the degree of luminal stenosis with different calcification volumes (%)
钙化容积（mm2） 钙化冠状动脉段（n） 敏感度 特异性 准确率 阳性预测值 阴性预测值 0~25 190 100.00 100.00 100.00 100.00 100.00 26~69 84 94.64 96.43 95.24 98.15 90.00 70~196 69 97.96 65.00 88.41 87.27 92.86 197~1375 53 85.71 36.36 75.47 83.72 40.00 χ2 22.19 33.42 46.13 28.46 28.15 P < 0.001 < 0.001 < 0.001 < 0.001 < 0.001 
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表 2 CCTA对不同钙化积分管腔狭窄程度的准确性（%）
Table 2. Accuracy of CCTAin diagnosing the degree of luminal stenosis with different calcification scores (%)
钙化积分（分） 钙化冠状动脉段（n） 敏感度 特异性 准确率 阳性预测值 阴性预测值 0~80 168 100.00 100.00 100.00 100.00 100.00 80~200 188 99.19 76.92 91.49 89.05 98.04 >200 40 92.86 75.00 87.50 89.66 91.82 χ2 10.607 13.904 17.385 13.563 11.747 P < 0.005 0.001 < 0.001 0.001 0.003
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