Kuettner Axel, Kopp Andreas F, Schroeder Stephen, Rieger Thilo, Brunn Juergen, Meisner Christoph, Heuschmid Martin, Trabold Tobias, Burgstahler Christof, Martensen Jens, Schoebel Wolfgang, Selbmann Hans-Konrad, Claussen Claus D
Department of Diagnostic Radiology, Eberhard-Karls-University, Tuebingen, Germany.
J Am Coll Cardiol. 2004 Mar 3;43(5):831-9. doi: 10.1016/j.jacc.2003.05.015.
The aim of the present study was to evaluate the diagnostic accuracy in detecting high-grade coronary stenoses in patients with known coronary artery disease (CAD) using multidetector computed tomography (MDCT).
The MDCT systems with electrocardiographic (ECG)-gating permit visualization of the coronary arteries. However, severe calcifications and higher heart rates are known to degrade image quality and limit correct diagnosis.
Sixty-six patients with proven CAD as assessed by conventional coronary angiography (CCA) were studied by MDCT (mean time 24 months postangiography). Total calcium score and all coronary arteries, including distal segments and side branches, were assessed with respect to evaluability, presence of high-grade coronary artery stenoses (>70%), and correct diagnosis. Results were compared to CCA.
A total of 105 lesions were detected by CCA. The MDCT correctly detected 39 lesions (sensitivity 37%, specificity 99%). The correct clinical diagnosis could be obtained in 24 patients (36%). Artifacts due to elevated heart rates or severe coronary artery calcification were the main cause of degraded image quality inhibiting correct diagnosis. In 21/66 patients (32%) all four major coronary vessel segments could be visualized. A threshold for maximum heart rate and a maximum calcification level were established (65 beats/min and an Agatston Score Equivalent of 335, respectively). A second analysis was made using these thresholds. Of all patients studied, 10/11 (91%) were correctly diagnosed when adhering to these thresholds.
When using MDCT as a noninvasive diagnostic modality to assess advanced CAD, it appears to be mandatory to preselect patients in order to achieve reliable results.
本研究旨在评估使用多排螺旋计算机断层扫描（MDCT）检测已知冠状动脉疾病（CAD）患者的高度冠状动脉狭窄的诊断准确性。
带有心电图（ECG）门控的MDCT系统可实现冠状动脉的可视化。然而，已知严重钙化和较高心率会降低图像质量并限制正确诊断。
对66例经传统冠状动脉造影（CCA）证实患有CAD的患者进行MDCT研究（平均时间为血管造影后24个月）。评估总钙化评分以及所有冠状动脉，包括远端节段和侧支，评估其可评估性、高度冠状动脉狭窄（>70%）的存在情况以及正确诊断情况。将结果与CCA进行比较。
CCA共检测到105个病变。MDCT正确检测到39个病变（敏感性37%，特异性99%）。24例患者（36%）可获得正确的临床诊断。心率升高或严重冠状动脉钙化导致的伪像是图像质量下降从而妨碍正确诊断的主要原因。在21/66例患者（32%）中，所有四个主要冠状动脉节段均可可视化。确定了最大心率阈值和最大钙化水平（分别为65次/分钟和阿加斯顿评分等效值335）。使用这些阈值进行了第二次分析。在所有研究患者中，遵循这些阈值时，10/11（91%）被正确诊断。
当使用MDCT作为评估晚期CAD的非侵入性诊断方法时，为了获得可靠结果，似乎必须预先选择患者。
