多层螺旋CT冠状动脉成像中源图像对冠状动脉以外病变的诊断价值
다층라선CT관상동맥성상중원도상대관상동맥이외병변적진단개치
Clinical value of multi-detector computed tomography source image on detecting extracoronary abnormalities
  • 万方数据
    中华心血管病杂志 중화심혈관병잡지
    Chinese Journal of Cardiology
    2013年 8期 687-692 ,共6页

    路莉%张龙江%朱飞鹏%谢丽响%马红%王佳丽%徐凯

    로리%장룡강%주비붕%사려향%마홍%왕가려%서개

    体层摄影术,螺旋计算机%冠状动脉疾病%肺疾病%纵隔疾病 體層攝影術,螺鏇計算機%冠狀動脈疾病%肺疾病%縱隔疾病
    체층섭영술,라선계산궤%관상동맥질병%폐질병%종격질병
    Tomography,spiral computed%Coronary disease%Lung diseases%Mediastinal diseases
    目的 评价多层螺旋CT冠状动脉成像中源图像对冠状动脉以外病变的诊断价值.方法 回顾性分析3240例进行冠状动脉检查的患者,由2名放射科医师对源图像进行分析,并记录肺窗、纵隔窗及骨窗观察的结果,按冠状动脉以外病变发生的部位进行病变统计,包括肺、腹部、纵隔、血管、骨及胸廓病变.同时按冠状动脉以外病变的临床意义进行评分:有临床意义组,包括1分为危及生命,需采取紧急措施的病变；2分为病变有临床及预后相关性,要求临床重视,需进一步进行检查和随访的病变；无临床意义组,包括3分为不需要进行进一步检查和随访的病变.不相关的病变(如主动脉粥样硬化、椎体退行性改变)未纳入统计.分别统计各种冠状动脉以外病变的发生率,并用肺窗、纵隔窗及骨窗分别进行观察,以及冠状动脉病变与冠状动脉以外病变的相关性.结果 3227例患者中发现330例(10.2％)有424个冠状动脉以外病变.20.3％(67/330)患者有多部位病变,其中16.5％(70/424)发生于肺组织,13.2％(56/424)发生于腹部,56.8％ (241/424)发生于纵隔,0.9％(4/424)发生于骨及胸廓,13.9％(53/424)是血管性病变.在纵隔病变中胸腔积液发生率为6.3％(24/380).冠状动脉以外心脏病变包括心腔扩大、心脏瓣膜病变、心包积液和(或)钙化、心房和(或)心室充盈缺损、心肌病、先天性心脏病和室壁瘤,发生率分别为14.7％(56/380)、15.5％ (59/380)、10.8％(41/380)、3.9％(15/380)、0.8％(3/380)、1.6％(6/380)和1.8％(7/380).临床意义评价结果,1、2、3分病变的发生率分别为8.5％(36/424)、81.1％(344/424)和10.4％ (44/424).用肺窗、纵隔窗及骨窗进行不同部位冠状动脉以外病变的观察差异有统计学意义(P均＜0.05).冠状动脉与冠状动脉以外病变相关性不高(x2=81.76,C=0.155,P＞0.05).2名医师观察有无冠状动脉以外病变的一致性非常好(Kappa值=0.934,P＞0.05).结论 冠状动脉CT成像源图像具有重要的临床诊断价值,可提示对临床有重要价值的冠状动脉以外病变.
    목적 평개다층라선CT관상동맥성상중원도상대관상동맥이외병변적진단개치.방법 회고성분석3240례진행관상동맥검사적환자,유2명방사과의사대원도상진행분석,병기록폐창、종격창급골창관찰적결과,안관상동맥이외병변발생적부위진행병변통계,포괄폐、복부、종격、혈관、골급흉곽병변.동시안관상동맥이외병변적림상의의진행평분:유림상의의조,포괄1분위위급생명,수채취긴급조시적병변；2분위병변유림상급예후상관성,요구림상중시,수진일보진행검사화수방적병변；무림상의의조,포괄3분위불수요진행진일보검사화수방적병변.불상관적병변(여주동맥죽양경화、추체퇴행성개변)미납입통계.분별통계각충관상동맥이외병변적발생솔,병용폐창、종격창급골창분별진행관찰,이급관상동맥병변여관상동맥이외병변적상관성.결과 3227례환자중발현330례(10.2％)유424개관상동맥이외병변.20.3％(67/330)환자유다부위병변,기중16.5％(70/424)발생우폐조직,13.2％(56/424)발생우복부,56.8％ (241/424)발생우종격,0.9％(4/424)발생우골급흉곽,13.9％(53/424)시혈관성병변.재종격병변중흉강적액발생솔위6.3％(24/380).관상동맥이외심장병변포괄심강확대、심장판막병변、심포적액화(혹)개화、심방화(혹)심실충영결손、심기병、선천성심장병화실벽류,발생솔분별위14.7％(56/380)、15.5％ (59/380)、10.8％(41/380)、3.9％(15/380)、0.8％(3/380)、1.6％(6/380)화1.8％(7/380).림상의의평개결과,1、2、3분병변적발생솔분별위8.5％(36/424)、81.1％(344/424)화10.4％ (44/424).용폐창、종격창급골창진행불동부위관상동맥이외병변적관찰차이유통계학의의(P균＜0.05).관상동맥여관상동맥이외병변상관성불고(x2=81.76,C=0.155,P＞0.05).2명의사관찰유무관상동맥이외병변적일치성비상호(Kappa치=0.934,P＞0.05).결론 관상동맥CT성상원도상구유중요적림상진단개치,가제시대림상유중요개치적관상동맥이외병변.
    Objective To assess the clinical value of multi-detector computed tomography (MDCT)source image on detecting extracoronary abnormalities in a large cohort of patients with suspected coronary artery disease (CAD).Method MDCT source images from 3240 consecutive patients (mean 64.5 years)with suspected CAD were reviewed retrospectively by 2 readers.Extra-coronary findings were classified according to involved organ and level of clinical significance.Following organs were examined:lungs,upper abdomen,spine,chest wall,mediastinum and vascularatures.Clinical relevance of extracoronary findings was considered as either "significant" or "non-significant"."Significant" findings were subclassified as score 1:findings necessitating immediate therapeutic actions,or score 2:findings with uncertain clinical or prognostic relevance,requiring clinical awareness,follow-up or further investigations (non-urgent)."Nonsignificant" findings were assigned to score 3:findings without clinical implication.The irrelevant incidental findings (e.g.spinal degenerative changes,aortic calcification) were not analyzed.Results Extracoronary findings was evidenced in 330 patients with 424 abnormalities,20.3％ (67/330) patients had multiple lesions,16.5％ lesions were located in the lungs,13.2％ lesions found in the upper abdomen,56.8％ (241/424)lesions evidenced in the mediastinum,0.9％ (4/424)lesions seen in the spine and chest wall,13.9％ (53/424) lesions were related to other vascular disease.Pleural effusion accounts for 5.5％ of the mediastinum lesions.Incidence of heart cavity enlargement,heart valve disease,pericardial effusion/ calcification,atrial/ventricular perfusion defects,myocardial disease,congenital heart disease,ventricular aneurysmwas 14.7％ (56/380),15.5％ (59/380),10.8％ (41/380),3.9％ (15/380),0.8％ (3/380),1.6％ (6/380),and 1.8％ (7/380) respectively.The clinical significance score 1-3 was 8.5％ (36/424),81.1％ (344/424),and 10.4％ (44/424) respectively.Incidence of detected extracoronary findings was the highest by bone window and the lowest by lung window.Incidence of extarcoronary findings was not related to CAD (x2 =81.76,C =0.155,P ＞ 0.05).Inter-reader agreement on extracoronary findings was excellent (Kappa =0.934,P ＞ 0.05).Conclusion Our data show that it is of clinical value to observe and report extracoronary findings with source image of cardiac MDCT.
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