Kuettner A, Beck T, Drosch T, Kettering K, Heuschmid M, Burgstahler C, Claussen C D, Kopp A F, Schroeder S
Department for Radiology, Division of Diagnostic Radiology, Eberhard-Karls University of Tuebingen, Tuebingen, Germany.
Heart. 2005 Jul;91(7):938-41. doi: 10.1136/hrt.2004.044735.
To evaluate image quality and clinical accuracy in detecting coronary artery lesions with a new multidetector spiral computed tomography (MDCT) generation with 16 detector slices and a temporal resolution of 188 ms.
124 consecutive patients scheduled for invasive coronary angiography (ICA) were additionally studied by MDCT (Sensation 16 Speed 4D). MDCTs were analysed with regard to image quality and presence of coronary artery lesions. The results were compared with ICA.
120 of 124 scans were successful. The image quality of all remaining 120 scans was sufficient (mean (SD) heart rate 64.2 (9.8) beats/min, range 43-95). The mean calcium mass was 167 (223) mg (range 0-1038). Thirteen coronary segments were evaluated for each patient (1560 segments in total). Image quality was graded as follows: excellent, 422 (27.1%) segments; good, 540 (34.6%) segments; moderate, 277 (17.7%) segments; heavily calcified, 215 (13.8%) segments; and blurred, 106 (6.8%) segments. ICA detected 359 lesions with a diameter stenosis > 50% and MDCT detected 304 of 359 (85%). Sensitivity, specificity, and positive and negative predictive values were 85%, 98%, 91%, and 96%, respectively. The correct clinical diagnosis (presence or absence of at least one stenosis > 50%) was obtained for 110 of 120 (92%) patients.
MDCT image quality can be further improved with 16 slices and faster gantry rotation time. These results in an unselected population underline the potential of MDCT to become a non-invasive diagnostic alternative, especially for the exclusion of coronary artery disease, in the near future.
使用具有16排探测器且时间分辨率为188毫秒的新一代多排螺旋计算机断层扫描（MDCT）评估检测冠状动脉病变的图像质量和临床准确性。
对124例计划进行有创冠状动脉造影（ICA）的连续患者额外进行MDCT（Sensation 16 Speed 4D）检查。对MDCT图像质量和冠状动脉病变情况进行分析，并将结果与ICA结果进行比较。
124例扫描中有120例成功。其余120例扫描的图像质量均足够（平均（标准差）心率64.2（9.8）次/分钟，范围43 - 95）。平均钙质量为167（223）毫克（范围0 - 1038）。每位患者评估13个冠状动脉节段（共1560个节段）。图像质量分级如下：优秀，422个（27.１%）节段；良好，540个（34.6%）节段；中等，277个（17.7%）节段；重度钙化，215个（13.8%）节段；模糊，106个（6.8%）节段。ICA检测到359处直径狭窄>50%的病变，MDCT检测到359处中的304处（85%）。敏感性、特异性、阳性和阴性预测值分别为85%、98%、91%和96%。120例患者中有110例（92%）获得了正确的临床诊断（存在或不存在至少一处狭窄>50%）。
16排探测器及更快的机架旋转时间可进一步提高MDCT图像质量。这些在未选择人群中的结果突显了MDCT在不久的将来成为无创诊断替代方法的潜力，尤其是用于排除冠状动脉疾病。
