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題名 | 利用量化的方法於冠狀動脈電腦斷層攝影對血管阻塞之評估=Diagnosing Total Occlusion by Using Coronary CT Angiography |
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作者 | 郭峯伶; 韓淑珍; 蔡建中; 林俊元; 陳怡; 王石補; 鄭凱元; Kuo, Feng-ling; Han, Shu-chen; Tsai, Chien-chung; Lin, Chun-yuan; Cheng, Yi; Wang, Shih-pu; Cheng, Kai-yuan; |
期刊 | 中華放射線技術學雜誌 |
出版日期 | 20130600 |
卷期 | 37:2 2013.06[民102.06] |
頁次 | 頁113-120 |
分類號 | 415.3161 |
語文 | chi |
關鍵詞 | 電腦斷層冠狀動脈血管攝影; 空間解析度; 血管完全阻塞; 血管狹窄; Coronary computed tomography angiography; Spatial resolution; Total occlusion; Vascular stenosis; |
中文摘要 | 電腦斷層冠狀動脈血管攝影(cardiac computed tomographic angiography, CCTA)由於受限於空間解析度(spatial resolution)的限制,導致高度的血管狹窄(high-grade stenosis)與慢性血管完全阻塞(chronic total occlusion, CTO)兩者的影像判讀較為困難,因此本研究旨在找出一套適用於判斷血管是否完全阻塞的參數,以提升影像診斷的準確率。本研究總共有40位受檢者,49個血管片段,在一個月內曾經接受CCTA與心導管(conventional coronary angiography, CCA)檢查,且CCA的結果為≥ 90%血管狹窄或血管完全阻塞,並且分別量測了血管狹窄的長度、血管狹窄處之斑塊CT值(CT number)、血管狹窄處近端與遠端的CT值差之比值(定義為ΔC)、三條血管(左前降枝left anterior descending, LAD、左迴旋枝left circumflex, LCx與右冠狀動脈right coronary artery, RCA)平均的CT值與遠端的CT值差之比值(定義為ΔD)。ΔD在線性迴歸(ordinary least squares multiple linear regression)的p= 0.002,呈現出統計上顯著性差異。利用ROC曲線(receiver operating characteristic curve)找出ΔD與部分血管完全阻塞的相對關係,以及ΔD的最佳切點(cut-off point),使其敏感度與特異性能有合理的平衡。結果當ΔD ≥ 19其ROC曲線下之面積是0.975為最大值,而其敏感度與特異性分別為95%與100%;陽性、陰性預測值為100%、96.67%。因此可利用量測ΔD來幫助臨床醫師判斷CCTA血管是否完全阻塞,而不受空間解析度與血管嚴重鈣化的影響。 |
英文摘要 | Due to the limited spatial resolution of coronary computed tomography angiography (CCTA), it is difficult to differentiate between the chronic total occlusion (CTO) and high-grade vascular stenosis imaging. So we tried to analyze parameters that can improve the diagnostic accuracy. The 40 patients and 49 segment lesions that underwent both coronary angiography and CCTA within 30 days were included in this study and conventional coronary angiography (CCA) reports had greater than 90% stenosis or total occlusion of the coronary artery. We measure the length of stenosis, CT number of the stenotic site within the plaque, the CT number difference between proximal and distal to the stenostic site contrast density within the coronary vessel (defined as ΔC), and the average CT number of the three coronary artery (left anterior descending; LAD, left circumflex; LCx, right coronary artery; RCA) minus the density value of the distal stenotic artery (defined as ΔD). The ΔD appeared significant (p < 0.05) as compared with degree of CCA stenosis. The best receiver-operating characteristic (ROC) curve was ΔD cut-off 19, the sensitivity and specificity of 95% and 100%, the positive predictive value (PPV) and negative predictive value (NPV) of 100% and 96.7% for the chronic total occlusion. CCTA has a high sensitivity and specificity for the differentiation between the total occlusion and vascular stenosis ≤ 90% if using ΔD ≥ 19 as criteria, and regardless of the spatial resolution and serious calcifications of vascular. |
本系統之摘要資訊系依該期刊論文摘要之資訊為主。