Knez A, Becker A, Becker C, Leber A, Boekstegers P, Reiser M, Steinbeck G
Medizinische Klinik I Ludwig-Maximilians-Universität München Klinikum Grosshadern Marchioninistr. 15 81366 München, Germany.
Z Kardiol. 2002 Aug;91(8):642-9. doi: 10.1007/s00392-002-0838-7.
Electron-beam CT (EBT) has been used for years as the gold standard to quantify coronary artery calcification as a marker of coronary atherosclerosis. With the introduction of Multi-Slice Spiral CT (MSCT) technology in 1999, EBT is now challenged in the determination of coronary calcium. The aim of this study was to determine the diagnostic accuracy of MSCT for the assessment of coronary calcium, comparing this new technique to EBT. The study population consisted of 54 male patients, aged 58 +/- 11 years with suspected coronary artery disease. For EBT, 40 axial slices (scan time = 100 ms, slice thickness = 3 mm) were acquired in one breath-hold (35 +/- 5 s) using an ECG-trigger at 80% of the RR interval. For MSCT, simultaneous acquisition of four axial slices (scan time = 250 ms, slice thickness = 2.5 mm) allowed the entire heart (40 slices) to be covered in one breath-hold (25 +/- 5 s) using a prospective ECG-trigger (R--450 ms). For quantification of coronary calcium the Agatston and the Volumetric calcium score (VCS) were applied. Mean Agatston score of the study group was calculated as 88 +/- 111 (median = 45), which is between the 25th and 75th age-corrected percentile of asymptomatic patients. For the Volumetric calcium score, number of lesions, calcium mass and density, no statistical difference was found between both imaging modalities. Agatston and Volumetric calcium score were statistically different between and within both scans. Mean variability of VCS of the two methods was calculated as 24% and was in the range of repeated EBT studies (14-44.9%). The Multi-Slice Spiral CT scanner is equivalent to EBT for the determination of coronary calcium and can, therefore, be used for calcium screening. Using a prospective ECG-trigger technique, the application of the Agatston method delivers statistically different results in comparison to EBT. With the application of the spiral mode technique, retrospective ECG-trigger and thinner slice thickness, further improvement in variability can be expected, thus allowing for follow-up studies to determine progression or regression of atherosclerosis with high accuracy.
多年来，电子束CT（EBT）一直被用作量化冠状动脉钙化的金标准，冠状动脉钙化是冠状动脉粥样硬化的一个标志。随着1999年多层螺旋CT（MSCT）技术的引入，EBT在冠状动脉钙化测定方面受到了挑战。本研究的目的是确定MSCT评估冠状动脉钙化的诊断准确性，并将这项新技术与EBT进行比较。研究人群包括54名男性患者，年龄为58±11岁，疑似患有冠状动脉疾病。对于EBT，在一次屏气（35±5秒）过程中，使用RR间期80%时的心电图触发，采集40层轴向图像（扫描时间 = 100毫秒，层厚 = 3毫米）。对于MSCT，同时采集4层轴向图像（扫描时间 = 250毫秒，层厚 = 2.5毫米），使用前瞻性心电图触发（R - 450毫秒），可在一次屏气（25±5秒）过程中覆盖整个心脏（40层）。为了量化冠状动脉钙化，应用了阿加斯顿评分法和容积钙评分（VCS）。研究组的平均阿加斯顿评分为88±111（中位数 = 45），处于无症状患者年龄校正后的第25至75百分位数之间。对于容积钙评分、病变数量、钙质量和密度，两种成像方式之间未发现统计学差异。阿加斯顿评分和容积钙评分在两次扫描之间以及每次扫描内部均存在统计学差异。两种方法的VCS平均变异性计算为24%，处于重复EBT研究的范围内（（14 - 44.9%）。多层螺旋CT扫描仪在冠状动脉钙化测定方面与EBT相当，因此可用于钙筛查。使用前瞻性心电图触发技术，与EBT相比，应用阿加斯顿方法得出的结果存在统计学差异。随着螺旋模式技术、回顾性心电图触发和更薄的层厚的应用，预计变异性会进一步改善，从而能够进行高精度的随访研究以确定动脉粥样硬化的进展或消退情况。
