Morgan-Hughes G J, Roobottom C A, Owens P E, Marshall A J
South West Cardiothoracic Centre, Plymouth NHS Trust, Derriford, Plymouth, UK.
Heart. 2005 Mar;91(3):308-13. doi: 10.1136/hrt.2004.034892.
To assess submillimetre coronary computed tomographic angiography (CTA) in comparison with invasive quantitative coronary angiography as the gold standard and to examine the effect of significant coronary artery calcification (CAC), which is known to impede lumen visualisation, on the accuracy of the examination.
After invasive coronary angiography, 58 patients underwent coronary imaging with a GE Lightspeed 16 computed tomography (CT) system. CAC was quantified after an ECG triggered acquisition with a low tube current. Coronary CTA was performed with retrospective ECG gating and a 16 x 0.63 mm collimation and was reconstructed with an effective 65-250 ms temporal resolution. All 13 major coronary artery segments were evaluated for the presence of > or = 50% stenosis, and compared with the gold standard.
One patient moved and could not be evaluated. All segments (except occluded segments) were evaluated for 57 patients. Overall the accuracy of coronary CTA for detection of > or = 50% stenosis was: sensitivity 83%, specificity 97%, positive predictive value 80%, and negative predictive value 97%. The number of diseased coronary arteries was correctly diagnosed in 34 of 38 (89%) patients overall. Altogether 21 of 57 (37%) patients had a CAC score > or = 400, which was predefined as representing significant CAC. Excluding these patients from the analysis improved the accuracy of coronary CTA to a sensitivity of 89%, specificity 98%, positive predictive value 79%, and negative predictive value 99%.
Non-invasive coronary angiography with submillimetre CT is reliable and accurate. It appears that a subgroup of patients may be selected based on CAC score in whom the investigation has even higher accuracy. Coronary CTA has reached the stage where it should be considered for a clinical role. Further research is required to define this role.
将亚毫米级冠状动脉计算机断层血管造影（CTA）与作为金标准的有创定量冠状动脉造影进行比较，并研究已知会妨碍管腔可视化的显著冠状动脉钙化（CAC）对检查准确性的影响。
在有创冠状动脉造影后，58例患者使用GE Lightspeed 16计算机断层扫描（CT）系统进行冠状动脉成像。在低管电流的心电图触发采集后对CAC进行定量。冠状动脉CTA采用回顾性心电图门控和16×0.63毫米准直进行，并以有效的65 - 250毫秒时间分辨率重建。对所有13个主要冠状动脉节段进行评估，看是否存在≥50%的狭窄，并与金标准进行比较。
1例患者移动，无法进行评估。对57例患者的所有节段（闭塞节段除外）进行了评估。总体而言，冠状动脉CTA检测≥50%狭窄的准确性为：敏感性83%，特异性97%（此处原文有误，应为97%），阳性预测值80%，阴性预测值97%。总体上38例患者中有34例（89%）的病变冠状动脉数量被正确诊断。57例患者中有21例（37%）的CAC评分≥400，这被预先定义为代表显著CAC。将这些患者排除在分析之外，冠状动脉CTA的准确性提高到敏感性89%，特异性98%，阳性预测值79%，阴性预测值99%。
亚毫米级CT的无创冠状动脉造影可靠且准确。似乎可以根据CAC评分选择一个亚组患者，在该亚组中检查的准确性更高。冠状动脉CTA已达到应考虑其临床作用的阶段。需要进一步研究来确定这一作用。
