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山东大学学报 (医学版) ›› 2024, Vol. 62 ›› Issue (10): 98-105.doi: 10.6040/j.issn.1671-7554.0.2024.0492

• 临床医学 • 上一篇    

基于CCTA的血管周围脂肪衰减指数对冠状动脉慢性全闭塞病变再通的预测价值

杨宝珠1,黄书苑1,于鑫鑫1,邓艳2,韩鹏熙3,刘晓龙4,王锡明1   

  1. 1.山东第一医科大学附属省立医院影像科, 山东 济南 250021;2.山东大学齐鲁医院放射科, 山东 济南 250012;3.山东第一医科大学第一附属医院放射科, 山东 济南 250014;4.济宁医学院附属医院影像科, 山东 济宁 272029
  • 发布日期:2024-10-12
  • 通讯作者: 王锡明. E-mail:wxming369@163.com
  • 基金资助:
    国家自然科学基金(82271993)

Predictive value of perivascular fat attenuation index based on CCTA for revascularization in chronic total occlusion of coronary artery

YANG Baozhu1, HUANG Shuyuan1, YU Xinxin1, DENG Yan2, HAN Pengxi3, LIU Xiaolong4, WANG Ximing1   

  1. 1. Department of Radiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan 250021, Shandong, China;
    2. Department of Radiology, Qilu Hospital of Shandong University, Jinan 250012, Shandong, China;
    3. Department of Radiology, The First Affiliated Hospital of Shandong First Medical University, Jinan 250014, Shandong, China;
    4. Department of Medical Imaging, Affiliated Hospital of Jining Medical University, Jining 272029, Shandong, China
  • Published:2024-10-12

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摘要： 目的 探究基于冠状动脉CT血管成像(coronary computed tomography angiography, CCTA)的冠状动脉周围脂肪衰减指数(fat attenuation index, FAI)对冠状动脉慢性全闭塞病变(chronic total occlusion, CTO)再通的预测价值。 方法 回顾性分析2012年11月至2023年6月期间行CCTA检查并接受经皮冠状动脉介入(percutaneous coronary intervention, PCI)治疗的冠状动脉完全闭塞患者(n=204)的临床资料,根据手术结果分为成功组(n=144)与失败组(n=60)。记录并分析两组患者的临床资料,闭塞段血管FAI,CTO病变的CCTA形态特征,包括病变部位［右冠状动脉(right coronary artery, RCA)、左前降支(left anterior descending artery, LAD)、左回旋支(left circumflex artery, LCX)］、病变长度、病变CT值、病变钙化斑块的体积、病变入口处的残端形态、病变弯曲角度是否>45°、病变是否为负性重构,并进行两组间比较。通过多因素Logistic回归分析筛选影响CTO病变再通的独立因素,并分别建立传统形态学特征模型及联合形态学特征和FAI的联合模型。通过受试者工作特征(receiver operating characteristic, ROC)曲线评价各模型的预测性能。 结果 两组间闭塞段FAI［(-82.33±10.61)HU vs.(-71.70±10.91)HU,P<0.001］、闭塞段CT值［69.85(55.95,86.25)HU vs. 58.25(47.00,72.83)HU,P<0.001］、闭塞段血管的钙化体积［20.92(2.25,52.80)mm3 vs. 5.69(0.00,25.75)mm3,P<0.001］、闭塞段长度［23.60(13.90,34.50)mm vs. 14.65(9.43,19.60)mm,P<0.001］ 等差异均有统计学意义;其中,闭塞段长度>23.05 mm、闭塞段FAI<-77.50 HU、闭塞段CT值>58.15 HU及闭塞血管负性重构是CTO病变再通失败的独立预测因素,将以上三种形态学特征因素建立传统形态学特征模型,传统形态学特征模型联合闭塞段FAI建立联合模型。联合模型的预测价值优于传统形态学特征模型的预测价值,AUC分别为0.857、0.787,P<0.001。 结论 FAI可以作为预测冠状动脉慢性全闭塞病变PCI手术结果的一个新的预测指标;在传统的影像学特征基础上,FAI能为CTO患者手术结果的预测提供新的增量价值。

关键词: 冠状动脉CT血管成像, 冠状动脉周围脂肪, 脂肪衰减指数, 慢性全闭塞病变, 经皮冠状动脉介入

Abstract: Objective To evaluate the predictive value of the perivascular fat attenuation index(FAI)based on coronary computed tomography angiography(CCTA)for revascularization in chronic total occlusion(CTO)of coronary artery. Methods A total of 204 patients with coronary artery total occlusion and treated with percutaneous coronary intervention(PCI)between November 2012 and June 2023 were retrospectively analyzed and divided into the successful group(n=144)and the unsuccessful group(n=60)according to the outcome of the procedure. The general clinical data, FAI of the occluded segment, and the morphological characteristics of CCTA of CTO lesions, including lesion site ［right coronary artery(RCA), left anterior descending artery(LAD), left circumflex artery(LCX)］, lesion length, lesion CT value, the volume of calcified plaques in the lesion, the stump morphology of the lesion entrance, whether the angle of curvature of the lesion was >45°, and whether the lesion was negatively remodeled, were analyzed and compared between the two groups. Independent factors affecting the revascularization of CTO lesion were screened by binary Logistic regression analysis, and a conventional model of morphological characteristics and a combined model of morphological characteristics and FAI were established. The predictive performance of each model was evaluated by the receiver operating characteristic(ROC)curve. Results The differences in FAI ［(-82.33±10.61)HU vs.(-71.70±10.91)HU, P<0.001］, CT value［69.85(55.95, 86.25)HU vs. 58.25(47.00, 72.83)HU, P<0.001］, calcified volume［20.92(2.25, 52.80)mm3 vs. 5.69(0.00, 25.75)mm3, P<0.001］, and length［23.60(13.90, 34.50)mm vs. 14.65(9.43, 19.60)mm, P<0.001］of the occluded segment were all statistically significant. The occluded segment length >23.05 mm, FAI of the occluded segment <-77.50 HU, CT value of the occluded segment >58.15 HU, and negative remodeling of the occluded vessel were identified as independent predictors of failure of CTO lesion revascularization. A conventional morphological characteristics model was established by combining the three morphological characteristics factors, and another model was established by combining the conventional morphological characteristics model with FAI. The combined model demonstrated superior predictive performance for the outcome of revascularization compared to the conventional morphological characteristics model, with AUC being 0.857 and 0.787, respectively, P<0.001. Conclusion The FAI may serve as a novel predictor of the outcomes of PCI surgery for CTO of the coronary artery. Based on the conventional morphological characteristics, FAI provides a novel approach to predicting the surgical outcomes of CTO patients.

Key words: Coronary computed tomography angiography, Pericoronary adipose tissue, Fat attenuation index, Chronic total occlusion, Percutaneous coronary intervention

中图分类号: 

  • R543
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