双源光子计数CT对重度钙化老年患者冠状动脉狭窄的诊断价值

doi:10.3969/j.issn.1003-9198.2025.12.003

摘要/Abstract

摘要： 目的探索双源光子计数CT(PCCT)冠状动脉成像对冠状动脉钙化严重(钙化积分≥400分)的老年患者冠状动脉梗阻性狭窄的诊断性能和临床应用价值。方法连续纳入2024年9月至2025年2月浙江大学医学院附属第二医院临床疑似或确诊冠心病、并行PCCT冠状动脉成像的老年患者(年龄≥65岁,钙化积分≥400分)41例(血管94支)。所有患者在PCCT检查后2周内接受有创冠状动脉造影(ICA)。以ICA结果为金标准,评估PCCT对冠状动脉梗阻性狭窄的诊断效能。结果患者平均年龄为(72.95±5.32)岁,其中男性26例(63.4%),平均钙化积分为(936.99±600.41)分。在患者水平,PCCT诊断冠状动脉梗阻性狭窄的敏感性、特异性、阳性预测值、阴性预测值、准确性分别为100.0%、33.3%、95.0%、100.0%、95.1%;在血管水平,上述指标分别为98.7%、58.8%、91.6%、90.9%、91.5%。结论对于冠状动脉钙化严重的老年患者,PCCT冠状动脉成像诊断冠状动脉阻塞性狭窄具有较高的准确性。

关键词: 光子计数CT, 冠状动脉成像, 老年人, 钙化斑块, 有创冠状动脉造影

Abstract: Objective To explore the diagnostic performance and clinical application value of dual-source photon-counting computed tomography (PCCT) coronary angiography for detecting coronary artery obstructive stenosis in elderly patients with severe coronary artery calcification. Methods This study continuously enrolled 41 elderly patients (aged ≥ 65 years; 94 blood vessels) who were clinically suspected or diagnosed with coronary heart disease and underwent PCCT coronary artery imaging at the Second Affiliated Hospital of Zhejiang University School of Medicine from September 2024 to February 2025, with a calcification score ≥400, and underwent invasive coronary angiography (ICA) within 2 weeks after PCCT. The diagnostic efficacy of PCCT for coronary obstructive stenosis was evaluated by using ICA results as the gold standard. Results The average age of the patients was 72.95±5.32 years old, including 26 male patients (63.4%). The mean calcification score was 936.99±600.41. At the patient level, the sensitivity, specificity, positive predictive value, negative predictive value and accuracy of PCCT in the diagnosis of coronary obstructive stenosis were 100.0%, 33.3%, 95.0%, 100.0% and 95.1%, respectively. At the vessel level, the corresponding values were 98.7%, 58.8%, 91.6%, 90.9% and 91.5%, respectively. Conclusions For elderly patients with severe coronary artery calcification, PCCT coronary angiography has a high accuracy in the diagnosis of obstructive coronary artery stenosis.

Key words: photon-counting computed tomography, coronary angiography, aged, calcified plaque, invasive coronary angiography

中图分类号:

R 541.4

金丹燕, 毛新禹, 周琦晶, 罗松, 徐晓俊. 双源光子计数CT对重度钙化老年患者冠状动脉狭窄的诊断价值[J]. 实用老年医学, 2025, 39(12): 1202-1206.

JIN Danyan, MAO Xinyu, ZHOU Qijing, LUO Song, XU Xiaojun. Diagnostic performance of dual-source photon-counting CT for coronary artery stenosis in elderly patients with severe calcification[J]. Practical Geriatrics, 2025, 39(12): 1202-1206.

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