Budoff M J, Oudiz R J, Zalace C P, Bakhsheshi H, Goldberg S L, French W J, Rami T G, Brundage B H
Department of Medicine, Harbor-UCLA Medical Center, Torrance, California, USA.
Am J Cardiol. 1999 Mar 15;83(6):840-5. doi: 10.1016/s0002-9149(98)01075-3.
Coronary angiography remains the diagnostic standard for establishing the presence, site, and severity of coronary artery disease (CAD). Electron beam computed tomography (EBCT), with its 3-dimensional capabilities, is an emerging technology with the potential for obtaining essentially noninvasive coronary arteriograms. The purpose of this study was to (1) test the accuracy of intravenous coronary arteriography using the EBCT to conventional coronary arteriographic images; (2) establish the inter-reader variability of this procedure; (3) determine the limitations due to location within the coronary tree; and (4) identify factors that contributed to improved image quality of the 3-dimensional EBCT angiograms. Fifty-two patients underwent both EBCT angiography and coronary angiography within 2 weeks. The coronary angiogram and the EBCT 3-dimensional images were analyzed by 2 observers blinded to the results of the other techniques. EBCT correctly identified 43 of 55 significantly stenosed arteries (sensitivity 78%), and correctly identified 118 of 130 of the nonobstructed arteries, yielding a specificity of 91% (p <0.001, chi-square analysis). The overall accuracy for EBCT angiography was 87%. Significantly more left main and anterior descending coronary arteries were adequately visualized than the circumflex and right coronary vessels (p = 0.003). Overall, 23 of 208 (11%) major epicardial vessels were noninterpretable by the blinded EBCT readers, primarily due to motion artifacts caused by cardiac and respiratory motion and poor electrocardiographic gating. The inter-reader variability was similar to that of angiography, and its high accuracy makes this a clinically useful test. This study demonstrates, by using intravenous contrast enhancement, that EBCT can clearly depict the coronary artery anatomy and can permit identification of coronary artery stenosis.
冠状动脉造影仍然是确定冠状动脉疾病（CAD）的存在、部位和严重程度的诊断标准。电子束计算机断层扫描（EBCT）具有三维成像能力，是一项新兴技术，有潜力获得基本无创的冠状动脉造影图像。本研究的目的是：（1）将使用EBCT的静脉冠状动脉造影与传统冠状动脉造影图像的准确性进行对比；（2）确定该检查方法在不同阅片者之间的变异性；（3）确定冠状动脉树内不同位置所导致的局限性；（4）识别有助于提高三维EBCT血管造影图像质量的因素。52例患者在2周内分别接受了EBCT血管造影和冠状动脉造影。由2名对其他技术结果不知情的观察者对冠状动脉造影和EBCT三维图像进行分析。EBCT正确识别出55条严重狭窄动脉中的43条（敏感性78%），并正确识别出130条无阻塞动脉中的118条，特异性为91%（p<0.001，卡方分析）。EBCT血管造影的总体准确率为87%。左主干和前降支冠状动脉的显影明显优于回旋支和右冠状动脉（p = 0.003）。总体而言，208条主要心外膜血管中有23条（11%）无法被不知情的EBCT阅片者解读，主要原因是心脏和呼吸运动引起的运动伪影以及心电图门控不佳。不同阅片者之间的变异性与血管造影相似，其高准确性使其成为一项临床有用的检查。本研究通过静脉注射造影剂增强显示，EBCT能够清晰描绘冠状动脉解剖结构，并可识别冠状动脉狭窄。
