微创医学

目的探讨柔性减影冠状动脉CT血管成像（Sub-CCTA）诊断冠状动脉狭窄的效能。方法选取40例疑似冠心病患者（356段冠状动脉）作为研究对象，所有患者均接受数字减影血管造影（DSA）、冠状动脉CT血管成像（CCTA）检查，并进行Sub-CCTA图像处理。以DSA为“金标准”，评估CCTA、Sub-CCTA对冠状动脉狭窄的诊断效能，诊断的一致性采用Kappa检验。结果 CCTA、Sub-CCTA和DSA对冠状动脉狭窄检出率的比较，差异无统计学意义（P>0.05），但CCTA、Sub-CCTA对轻度狭窄检出率高于DSA，对重度狭窄检出率低于DSA（P<0.05）。以DSA检查结果为“金标准”，CCTA诊断冠状动脉狭窄与DSA诊断结果的一致性尚可（Kappa=0.468），Sub-CCTA诊断冠状动脉狭窄与DSA诊断结果的一致性好（Kappa=0.706）。356段冠状动脉中，CCTA共检出伴斑块节段204段。CCTA、Sub-CCTA对存在斑块的冠状动脉狭窄检出率差异有统计学意义（P<0.05）。其中，对于存在钙化斑块、混合斑块的冠状动脉节段，CCTA狭窄检出率高于Sub-CCTA（P<0.05）；对于非钙化斑块的冠状动脉节段，CCTA、Sub-CCTA狭窄检出率差异无统计学意义（P>0.05）。以DSA检查结果为“金标准”，CCTA诊断斑块冠状动脉狭窄与DSA诊断结果的一致性较差（Kappa=0.223），Sub-CCTA诊断斑块冠状动脉狭窄与DSA诊断结果的一致性尚可（Kappa=0.618）。结论 CCTA与Sub-CCTA对冠状动脉狭窄的检出率与DSA相当，CCTA诊断冠状动脉狭窄与DSA诊断结果一致性尚可，Sub-CCTA诊断冠状动脉狭窄与DSA诊断结果一致性好。当冠状动脉存在斑块时，Sub-CCTA诊断冠状动脉狭窄的效能优于CCTA。

Objective To evaluate the diagnostic efficacy of subtraction-coronary computed tomographic angiography (Sub-CCTA) for coronary artery stenosis. Methods A total of 40 patients with suspected coronary heart disease (356 coronary artery segments) were enrolled as study subjects. All patients underwent digital subtraction angiography (DSA) and coronary computed tomographic angiography (CCTA), followed by Sub-CCTA image processing. Taking DSA as the reference standard, the diagnostic efficacy of CCTA and Sub-CCTA for coronary artery stenosis was evaluated. And the diagnostic consistency was assessed using the Kappa test. Results There was no statistically significant difference in the detection rate of coronary artery stenosis among CCTA, Sub-CCTA and DSA (P>0.05). However, CCTA and Sub-CCTA showed a higher detection rate for mild stenosis but a lower detection rate for severe stenosis than DSA (P<0.05). Using DSA as the reference standard, CCTA showed moderate agreement with DSA in diagnosing coronary artery stenosis (Kappa=0.468), while Sub-CCTA showed good agreement (Kappa=0.706). Of the 356 coronary artery segments, 204 segments with plaques were detected by CCTA. There was a statistically significant difference in the detection rate of coronary artery stenosis with plaques between CCTA and Sub-CCTA (P<0.05). Among them, the stenosis detection rate of CCTA was higher than that of Sub-CCTA in coronary artery segments with calcified plaques and mixed plaques (P<0.05), whereas no statistically significant difference was found between CCTA and Sub-CCTA in coronary artery segments with non-calcified plaques (P>0.05). Using DSA as the reference standard, CCTA showed poor agreement with DSA in diagnosing coronary artery stenosis with plaques (Kappa=0.223), whereas Sub-CCTA showed moderate agreement (Kappa=0.618). Conclusion The detection rates of coronary artery stenosis by CCTA and Sub‑CCTA were comparable to those by DSA. CCTA showed moderate agreement with DSA in diagnosing coronary artery stenosis, whereas Sub-CCTA showed good agreement. In the presence of coronary artery plaques, Sub‑CCTA demonstrated superior diagnostic efficacy for coronary artery stenosis compared with CCTA.