使用具有16×0.75准直和375毫秒旋转的多探测器CT检测冠状动脉狭窄。

Detection of coronary artery stenoses using multi-detector CT with 16 x 0.75 collimation and 375 ms rotation.

作者信息

Achenbach Stephan, Ropers Dieter, Pohle Falk-Karsten, Raaz Dorette, von Erffa Johannes, Yilmaz Attila, Muschiol Gerd, Daniel Werner G

机构信息

Department of Internal Medicine II (Cardiology), University of Erlangen-Nürnberg, Ulmenweg 18, 91054 Erlangen, Germany.

出版信息

Eur Heart J. 2005 Oct;26(19):1978-86. doi: 10.1093/eurheartj/ehi326. Epub 2005 May 27.

DOI:10.1093/eurheartj/ehi326

PMID:15923203

Abstract

AIMS

Insufficient spatial and temporal resolutions have limited image quality and accuracy of multi-detector CT (MDCT) for coronary artery visualization and detection of stenoses. We assessed the accuracy of a new 16-slice scanner with 370 ms rotation and 0.75 mm collimation for detection of coronary stenoses using an analysis approach based on coronary artery segments.

METHODS AND RESULTS

Fifty consecutive patients scheduled for diagnostic coronary angiography in stable clinical condition and sinus rhythm were enrolled. All patients with a heart rate > 60 b.p.m. received 100 mg atenolol p.o. and up to four doses of 5 mg metoprolol i.v. before the scan. MDCT was performed using 16 x 0.75 mm collimation, 120 kV, and ECG-gated tube current modulation. Ninety millilitres of contrast agent was injected intravenously. MDCT images were visually analysed using the 16-segment coronary artery model of the American Heart Association and compared with invasive, quantitative coronary angiography in a blinded fashion. A significant stenosis was assumed if the diameter reduction was > or = 50%. Mean heart rate was 58 b.p.m. during MDCT. After exclusion of two patients with not fully evaluable data sets, MDCT correctly identified at least one coronary stenosis in all 25 patients with significant coronary lesions in angiography and correctly demonstrated the absence of stenoses in 19/23 patients (sensitivity 100%, specificity 83%). Sensitivity and specificity for all 50 patients were 93 and 83%, respectively. On a per-segment basis, nine coronary segments distal of total occlusions and 128 coronary segments with a reference diameter < 1.5 mm were excluded from the analysis. Twenty-eight of the included 663 segments (4%) were unevaluable due to calcification or motion artefact. In the remaining 635 segments, 50/53 stenoses were detected by MDCT (sensitivity 94%, specificity 96%, negative predictive value 99%, positive predictive value 69%).

CONCLUSION

Increasing temporal and spatial resolutions of MDCT lead to improved evaluation and diagnostic accuracy for detection of coronary stenoses.

摘要

目的

空间和时间分辨率不足限制了多排螺旋CT（MDCT）用于冠状动脉显影及狭窄检测的图像质量和准确性。我们使用基于冠状动脉节段的分析方法，评估了一台新的具有370毫秒旋转时间和0.75毫米准直的16层扫描仪检测冠状动脉狭窄的准确性。

方法与结果

纳入50例临床病情稳定且为窦性心律、计划接受诊断性冠状动脉造影的连续患者。所有心率>60次/分钟的患者在扫描前口服100毫克阿替洛尔，并静脉注射最多4剂5毫克美托洛尔。使用16×0.75毫米准直、120千伏和心电图门控管电流调制进行MDCT检查。静脉注射90毫升造影剂。使用美国心脏协会的16节段冠状动脉模型对MDCT图像进行视觉分析，并与有创定量冠状动脉造影进行盲法比较。如果直径减少≥50%，则认为存在显著狭窄。MDCT检查期间平均心率为58次/分钟。排除2例数据集评估不完全的患者后，MDCT在所有25例血管造影显示有显著冠状动脉病变的患者中正确识别出至少一处冠状动脉狭窄，并在19/23例患者中正确显示无狭窄（敏感性100%，特异性83%）。50例患者的敏感性和特异性分别为93%和83%。在每个节段基础上，分析中排除了完全闭塞远端的9个冠状动脉节段和参考直径<1.5毫米的128个冠状动脉节段。663个纳入节段中有28个（4%）因钙化或运动伪影而无法评估。在其余635个节段中，MDCT检测到50/53处狭窄（敏感性94%，特异性96%，阴性预测值99%，阳性预测值69%）。