CAJ | 학술논문

目的：以经胸心脏超声（TTE）为对照，探讨双源CT（DSCT）评估主动脉瓣狭窄（AS）的可行性及准确性。方法回顾性分析53例行DSCT冠状动脉成像及TTE检查，经TTE诊断均为AS的患者。 DSCT面积法测量收缩期最大主动脉瓣口面积（AVA），TTE采用连续性方程计算AVA值。根据测量的AVA值，将AS分为轻度、中度及重度狭窄。采用Pearson相关分析及Bland-Altman法分析DSCT与TTE测量AVA相关性及一致性。采用Kappa分析2种方法评估AS狭窄程度一致性。结果 DSCT测量AVA值为（1.45±0.35）cm2，TTE所得AVA值为（1.33±0.36 cm）2，2种方法所测AVA值间具有明显相关性（r＝0.92，P＜0.01），Bland-Altman分析显示2种检查方法测量AVA值一致性较好，但DSCT所测AVA值略高于TTE。53例AS患者经TTE证实，轻度狭窄13例、中度狭窄21例、重度狭窄19例；其中3例患者TTE诊断为轻度狭窄，而DSCT诊断为阴性；6例DSCT评估为轻度狭窄，而TTE 证实为中度狭窄。 Kappa 分析示2种方法检测主动脉瓣狭窄程度一致性较好（ Kappa＝0.75，P＜0.01）。结论 DSCT测量AS患者AVA是可行的，可对中、重度AS进行准确评估。
목적：이경흉심장초성（TTE）위대조，탐토쌍원CT（DSCT）평고주동맥판협착（AS）적가행성급준학성。방법회고성분석53례행DSCT관상동맥성상급TTE검사，경TTE진단균위AS적환자。 DSCT면적법측량수축기최대주동맥판구면적（AVA），TTE채용련속성방정계산AVA치。근거측량적AVA치，장AS분위경도、중도급중도협착。채용Pearson상관분석급Bland-Altman법분석DSCT여TTE측량AVA상관성급일치성。채용Kappa분석2충방법평고AS협착정도일치성。결과 DSCT측량AVA치위（1.45±0.35）cm2，TTE소득AVA치위（1.33±0.36 cm）2，2충방법소측AVA치간구유명현상관성（r＝0.92，P＜0.01），Bland-Altman분석현시2충검사방법측량AVA치일치성교호，단DSCT소측AVA치략고우TTE。53례AS환자경TTE증실，경도협착13례、중도협착21례、중도협착19례；기중3례환자TTE진단위경도협착，이DSCT진단위음성；6례DSCT평고위경도협착，이TTE 증실위중도협착。 Kappa 분석시2충방법검측주동맥판협착정도일치성교호（ Kappa＝0.75，P＜0.01）。결론 DSCT측량AS환자AVA시가행적，가대중、중도AS진행준학평고。
Objective To discuss the feasibility and accuracy of dual-source CT ( DSCT) in the evaluation of aortic stenosis ( AS) with transthoracic echocardiography ( TTE) as reference.Methods A total of 53 patients who underwent both DSCT and TTE were prospectively evaluated.All of them were assessed by TTE for aortic stenosis.Maximum aortic valve area ( AVA) in systolic phase was measured with DSCT , and was compared to that index obtained from the continuity equation on TTE.The severity of AS was graded as mild , moderate , or severe according to the AVA.Linear regression analysis and Bland-Altman plots were used to compare the AVA measured by using CT and TTE.Agreement on semi-quantitative grades of AS severity between the two methods was tested by using Kappa statistics.Results The mean AVA using DSCT was (1.45 ±0.35 ) cm2 compared to the mean AVA of ( 1.33 ±0.36 ) cm2 using TTE, with a significant correlation between them (r=0.92,P<0.01).Bland-Altman analysis demonstrated good inter-modality consistency between DSCT and TTE.However , DSCT demonstrated a slight overestimation of the AVA compared to TTE.As identified by TTE, there were 53 patients with AS, 13 with mild AS, 21 with moderate AS , and 19 with severe AS.In 3 patients DSCT showed no AS , TTE detected mild AS.In 6 cases, TTE had graded the stenosis as moderate , but the stenosis degree was graded as mild using DSCT.Kappa analysis showed a good agreement between the two methods on semi -quantitative grades of aortic stenosis severity (Kappa=0.75,P<0.01).Conclusion AVA measurements using DSCT is feasible and reasonably accurate for those patients with moderate to severe aortic stenosis.