Sandstede J, Beer M, Pabst T, Köstler H, Hahn D
Institut für Röntgendiagnostik der Universität Würzburg.
Rofo. 2003 Apr;175(4):477-83. doi: 10.1055/s-2003-38448.
Invasive coronary angiography is the gold standard for the primary diagnosis of coronary artery disease (CAD). At most, only every other examination leads to revascularization therapy. The other coronary angiographies could be replaced by non-invasive examinations. Diagnosing CAD by cardiac MRI and CT can utilize three different strategies: detection of coronary calcifications; imaging of coronary artery stenoses; and detection of restricted myocardial perfusion reserve. Applications are coronary calcification scoring by CT, coronary angiography by MRI or CT, stress cine MRI, and stress perfusion MRI. All these methods are currently used clinically because of their high negative predictive value, i.e., a normal result mostly rules out a hemodynamically significant CAD. For a reasonable implication in clinical practice, however, the pre-test probability must be considered to avoid needless examinations. High pre-test probability invariably demands invasive coronary angiography for planning or performing revascularization therapy. Intermediate pre-test probability, on the contrary, justifies to defer further imaging studies if MRI or CT is normal. Thus, adequate selection of patients for cardiac MRI and CT may reduce the number of invasive coronary angiographies in the future.
有创冠状动脉造影术是冠状动脉疾病（CAD）初步诊断的金标准。最多只有每隔一次的检查会导致血运重建治疗。其他冠状动脉造影检查可以被无创检查所取代。通过心脏磁共振成像（MRI）和计算机断层扫描（CT）诊断CAD可以采用三种不同策略：检测冠状动脉钙化；冠状动脉狭窄成像；检测受限的心肌灌注储备。其应用包括CT冠状动脉钙化评分、MRI或CT冠状动脉造影、负荷电影MRI和负荷灌注MRI。所有这些方法目前都在临床中使用，因为它们具有较高的阴性预测价值，即正常结果大多可排除血流动力学显著的CAD。然而，为了在临床实践中合理应用，必须考虑检查前概率以避免不必要的检查。高检查前概率总是需要进行有创冠状动脉造影以规划或实施血运重建治疗。相反，中等检查前概率情况下，如果MRI或CT结果正常，则有理由推迟进一步的影像学检查。因此，为心脏MRI和CT适当选择患者可能会在未来减少有创冠状动脉造影的数量。
