使用64层螺旋计算机断层扫描进行无创冠状动脉造影的诊断准确性

Diagnostic accuracy of noninvasive coronary angiography using 64-slice spiral computed tomography.

作者信息

Raff Gilbert L, Gallagher Michael J, O'Neill William W, Goldstein James A

机构信息

Cardiology Division, William Beaumont Hospital, Royal Oak, Michigan 48380, USA.

出版信息

J Am Coll Cardiol. 2005 Aug 2;46(3):552-7. doi: 10.1016/j.jacc.2005.05.056.

DOI:10.1016/j.jacc.2005.05.056

PMID:16053973

Abstract

OBJECTIVES

The aim of our study was to evaluate the diagnostic accuracy of multislice computed tomography (MSCT) coronary angiography using a new 64-slice scanner.

BACKGROUND

The new 64-slice MSCT scanner has improved spatial resolution of 0.4 mm and a faster rotation time (330 ms) compared to prior MSCT scanners.

METHODS

We studied 70 consecutive patients undergoing elective invasive coronary angiography. Patients were excluded for atrial fibrillation, but not for high heart rate, coronary calcification, or obesity. All vessels were analyzed, including those <1.5 mm in diameter; MSCT lesions were analyzed quantitatively as well as by a qualitative scale and compared to quantitative coronary angiography (QCA). Results were also analyzed for significant coronary stenoses (over 50% luminal narrowing) by segment, by artery, and by patient.

RESULTS

All scans showed diagnostic image quality. Of 1,065 segments, 935 (88%) could be evaluated, and 773 of 935 (83%) could be assessed quantitatively by both MSCT and QCA. The Spearman correlation coefficient between MSCT and QCA was 0.76 (p < 0.0001). Bland-Altman analysis demonstrated a mean difference in percent stenosis of 1.3 +/- 14.2%. A total of 26% of patients had calcium scores above 400 Agatston U, 25% had heart rates >70 beats/min, and 50% were obese. Specificity, sensitivity, and positive and negative predictive values for the presence of significant stenoses were: by segment (n = 935), 86%, 95%, 66%, and 98%, respectively; by artery (n = 279), 91%, 92%, 80%, and 97%, respectively; by patient (n = 70), 95%, 90%, 93%, and 93%, respectively.

CONCLUSIONS

Our results indicate high quantitative and qualitative diagnostic accuracy of 64-slice MSCT in comparison to QCA in a broad spectrum of patients.

摘要

目的

我们研究的目的是使用新型64层扫描仪评估多层螺旋计算机断层扫描（MSCT）冠状动脉造影的诊断准确性。

背景

与之前的MSCT扫描仪相比，新型64层MSCT扫描仪的空间分辨率提高到了0.4毫米，旋转时间更快（330毫秒）。

方法

我们研究了70例连续接受选择性有创冠状动脉造影的患者。房颤患者被排除，但心率快、冠状动脉钙化或肥胖患者未被排除。分析了所有血管，包括直径<1.5毫米的血管；对MSCT病变进行了定量分析，并采用定性量表进行分析，并与定量冠状动脉造影（QCA）进行比较。还按节段、动脉和患者对显著冠状动脉狭窄（管腔狭窄超过50%）的结果进行了分析。

结果

所有扫描均显示出诊断图像质量。在1065个节段中，935个（88%）可以评估，935个中的773个（83%）可以通过MSCT和QCA进行定量评估。MSCT和QCA之间的Spearman相关系数为0.76（p<0.0001）。Bland-Altman分析显示狭窄百分比的平均差异为1.3±14.2%。共有26%的患者钙评分高于400阿加斯顿单位，25%的患者心率>70次/分钟，50%的患者肥胖。显著狭窄存在的特异性、敏感性以及阳性和阴性预测值分别为：按节段（n = 935），分别为86%、95%、66%和98%；按动脉（n = 279），分别为91%、92%、80%和97%；按患者（n = 70），分别为95%、90%、93%和93%。