光子计数CT超高分辨率冠状动脉血管成像在老年冠心病中的诊断价值

doi:10.3969/j.issn.1003-9198.2025.12.006

摘要/Abstract

摘要： 目的评估光子计数CT(PCCT)的超高分辨率冠状动脉CT血管成像(CCTA)在老年冠心病中的诊断准确性。方法回顾性分析2024年7月至2025年1月在南京医科大学附属老年医院同期接受PCCT-CCTA超高分辨率扫描和侵入性冠状动脉造影(ICA)检查的57例老年患者的临床资料。以ICA为金标准,通过组内相关系数(ICC)和Bland-Altman分析评价PCCT与ICA在狭窄程度测量上的一致性,并计算0.2、0.4、0.8 mm层厚下CCTA的诊断效能(狭窄率≥50%为有临床意义)。结果 ICC分析显示,0.2 mm层厚在血管段水平CCTA与ICA具有极好的一致性(ICC=0.98,95%CI:0.97～0.98);Bland-Altman分析显示,两种方法的平均偏倚为－0.44%,其95%一致性界限为(－12.39%～11.52%)。CCTA的诊断性能随层厚减小而提升,在段水平及血管水平,0.2 mm层厚均展现出最优的诊断效能。结论在老年冠心病患者中,基于PCCT的超高分辨率CCTA与ICA在评估冠状动脉狭窄程度方面具有高度一致性,其中超高分辨率重建模式具有更高的诊断准确性,是评估冠状动脉狭窄可靠的影像学方法。

关键词: 老年人, 冠心病, 光子计数CT, 冠状动脉CT血管成像, 侵入性冠状动脉造影, 诊断准确性

Abstract: Objective To evaluate the diagnostic accuracy of ultra-high-resolution coronary computed tomography angiography (CCTA) using photon-counting CT (PCCT) in elderly patients with coronary artery disease (CAD). Methods A retrospective analysis was conducted on 57 patients (mean age 70.9±6.4 years, 43 males) who underwent both ultra-high-resolution PCCT-CCTA and invasive coronary angiography (ICA) at Geriatric Hospital of Nanjing Medical University from July 2024 to January 2025. With ICA as the gold standard, the consistency between PCCT-CCTA and ICA was assessed using the intraclass correlation coefficient (ICC) and Bland-Altman analysis. The diagnostic performance (sensitivity, specificity, accuracy) of CCTA reconstructions at 0.2 mm, 0.4 mm, and 0.8 mm slice thickness was calculated, with stenosis ≥50% considered hemodynamically significant. Results ICC analysis indicated excellent consistency between CCTA and ICA at the 0.2 mm segment-level (ICC=0.98, 95%CI: 0.97－0.98). Bland-Altman analysis showed a mean bias of －0.44%, with 95% limits of consistency ranging from －12.39% to 11.52%. The diagnostic performance of CCTA exhibited an inverse relationship with slice thickness. The 0.2 mm reconstruction demonstrated superior diagnostic performance at both the segment level and vessel level. Conclusions In elderly CAD patients, CCTA based on photon-counting CT shows high consistency with ICA for quantifying coronary artery stenosis. The Ultra-high-resolution reconstruction mode (0.2 mm) provides superior diagnostic accuracy, which could be used as a reliable noninvasive imaging method for coronary stenosis evaluation.

Key words: aged, coronary artery disease, photon-counting CT, coronary CT angiography, invasive coronary angiography, diagnostic accuracy

中图分类号:

R 541.4

张慧欣, 胡秋菊, 袁勇, 杨亚茹, 赵艳娥, 徐天雄, 金东生, 陈骥梁, 卢光明, 罗松. 光子计数CT超高分辨率冠状动脉血管成像在老年冠心病中的诊断价值[J]. 实用老年医学, 2025, 39(12): 1217-1222.

ZHANG Huixin, HU Qiuju, YUAN Yong, YANG Yaru, ZHAO Yan’e, XU Tianxiong, JIN Dongsheng, CHEN Jiliang, LU Guangming, LUO Song. Diagnostic value of ultra-high-resolution coronary angiography using photon-counting CT for coronary artery disease in elderly patients[J]. Practical Geriatrics, 2025, 39(12): 1217-1222.

参考文献

[1] 国家心血管病中心, 中国心血管健康与疾病报告编写组, 胡盛寿. 中国心血管健康与疾病报告2024概要[J]. 中国循环杂志, 2025, 40(6): 521-559.
[2] NARULA J, CHANDRASHEKHAR Y, AHMADI A, et al. SCCT 2021 expert consensus document on coronary computed tomographic angiography: a report of the society of cardiovascular computed tomography[J]. J Cardiovasc Comput Tomogr, 2021, 15(3): 192-217.
[3] SERRUYS P W, KOTOKU N, NØRGAARD B L, et al. Computed tomographic angiography in coronary artery disease[J]. EuroIntervention, 2023, 18(16): e1307-e1327.
[4] KNUUTI J, BALLO H, JUAREZ-OROZCO L E, et al. The performance of non-invasive tests to rule-in and rule-out significant coronary artery stenosis in patients with stable angina: a meta-analysis focused on post-test disease probability[J]. Eur Heart J, 2018, 39(35): 3322-3330.
[5] 中华医学会放射学分会,《中华放射学杂志》光子计数CT临床应用协作组. 光子计数CT临床应用专家共识[J].中华放射学杂志,2025, 59(4):364-383.
[6] ZHANG H, JIN D. Giant thrombus in a coronary artery bypass graft: comparison of photon-counting detector CT and energy-integrating detector CT[J]. Radiology, 2024, 313(3): e241326.
[7] TANG W T, ZHAO Y E. Dural arteriovenous fistula at photon-counting CT angiography[J]. Radiology, 2024, 313(1): e240954.
[8] REN L, DUAN X, AHN R, et al. Photon-counting-detector CT: technology overview and radiation dose reduction[J]. Br J Radiol,2025:tqaf116.
[9] 朱佳佳, 陈骥梁, 金东生, 等. 超高分辨率光子计数探测器CT评估冠状动脉斑块破裂1例[J]. 中华放射学杂志, 2025, 59(5):604-606.
[10] 高雨洁, 胡秋菊, 陈骥梁, 等. 超高分辨率光子计数CT评估冠状动脉支架植入术后管腔再狭窄1例[J]. 中华放射学杂志, 2024, 58(7):763-765.
[11] ZHAO Y E, HU Q, ZHU J, et al. Evaluation of low-dose chest scans for coronary artery calcium scoring using photon-counting computed tomography with different slice thicknesses and iterative reconstruction levels[J]. Quant Imaging Med Surg, 2025, 15(4): 3565-3574.
[12] NEGLIA D, ROVAI D, CASELLI C, et al. Detection of significant coronary artery disease by noninvasive anatomical and functional imaging[J]. Circ Cardiovasc Imaging, 2015, 8(3): e002179.
[13] BUDOFF M J, LI D, KAZEROONI E A, et al. Diagnostic accuracy of noninvasive 64-row computed tomographic coronary angiography (CCTA) compared with myocardial perfusion imaging (MPI): the PICTURE study, a prospective multicenter trial[J]. Acad Radiol, 2017, 24(1): 22-29.
[14] STOLZMANN P, SCHEFFEL H, SCHERTLER T, et al. Radiation dose estimates in dual-source computed tomography coronary angiography[J].Eur Radiol,2008,18(3):592-9.
[15] SYMONS R, SANDFORT V, MALLEK M, etal. Coronary artery calcium scoring with photon-counting CT: first in vivo human experience[J]. Int J Cardiovasc Imaging, 2019, 35(4): 733-739.
[16] VANDER WERF N R, SI-MOHAMED S, RODESCH P A, et al. Coronary calcium scoring potential of large field-of-view spectral photon-counting CT: a phantom study[J]. Eur Radiol, 2022, 32(1): 152-162.
[17] HAGAR M T, SOSCHYNSKI M, SAFFAR R, et al. Accuracy of ultrahigh-resolution photon-counting CT for detecting coronary artery disease in a high-risk population[J]. Radiology, 2023, 307(5): e223305.
[18] WANG M, LI X, XU Z, et al. Photon-counting detector CTA in standard- and ultrahigh-resolution modes for diagnosing coronary artery stenosis using invasive angiography as the reference: a prospective study[J]. AJR Am J Roentgenol, 2025: 1-13.
[19] LAUX G S, HALFMANN M C, KAVERMANN L, et al. Ultra-high resolution photon-counting detector coronary CT minimizes overestimation bias compared to invasive reference[J]. Eur J Radiol, 2025, 188: 112154.
[20] 中华医学会心血管病学分会. 冠状动脉微血管疾病诊断和治疗中国专家共识(2023版)[J]. 中华心血管病杂志,2024,52(5):460-492.
[21] SAKAI K, SHIN D, SINGH M, et al. Diagnostic performance and clinical impact of photon-counting detector computed tomography in coronary artery disease[J]. J Am Coll Cardiol, 2025, 85(4): 339-348.
[22] CELENG C, LEINER T, MAUROVICH-HORVAT P, et al. Anatomical and functional computed tomography for diagnosing hemodynamically significant coronary artery disease: a meta-analysis[J]. JACC Cardiovasc Imaging, 2019, 12(7 Pt 2): 1316-1325.
[23] PONTONE G, BAGGIANO A, ANDREINI D, et al. Stress computed tomography perfusion versus fractional flow reserve CT derived in suspected coronary artery disease: the PERFECTION study[J]. JACC Cardiovasc Imaging, 2019, 12(8 Pt 1): 1487-1497.