血管内增强、心率和钙化积分对多层螺旋计算机断层扫描冠状动脉造影诊断准确性的影响。

Impact of intravascular enhancement, heart rate, and calcium score on diagnostic accuracy in multislice computed tomography coronary angiography.

作者信息

Cademartiri Filippo, Runza Giuseppe, Mollet Nico R, Luccichenti Giacomo, Belgrano Manuel, Bartolotta Tommaso Vicenzo, Galia Massimo, Midiri Massimo, Pozzi Mucelli Roberto, Krestin Gabriel P

机构信息

Dipartimento di Radiologia, Erasmus Medical Center, Rotterdam, The Netherlands.

出版信息

Radiol Med. 2005 Jul-Aug;110(1-2):42-51.

PMID:16163138

Abstract

PURPOSE

To assess the effect of intravascular enhancement, heart rate, and calcium score on diagnostic accuracy in the detection of significant coronary artery stenosis using 16-row multislice computed tomography (MSCT).

MATERIALS AND METHODS

One hundred patients (88 males; 59+/-11 years) with suspected coronary artery disease who had undergone conventional coronary angiography (CA) and MSCT-CA were retrospectively enrolled for the study. Patients underwent a MSCT-CA, with the following protocol: collimation 16x0.75 mm, gantry rotation time 420 ms, feed/rotation 2.8 mm, kV 120, mAs 400-500. The protocol for contrast material administration was 100 ml of Iodixanol 320 mgI/ml at 4 ml/s and the scan delay was defined with a bolus tracking technique. In all patients vascular enhancement was measured in the aortic root, and in the left and right coronary arteries. The average vascular enhancement was used to divide the population in two groups of 50 patients each, one with lower enhancement (Low), and one with higher enhancement (High). In the two groups diagnostic accuracy (per coronary segment) for the detection of significant stenosis (= or >50% lumen reduction) was evaluated in vessels = or >2 mm in diameter using quantitative CA as the reference standard. The differences in diagnostic accuracy were compared with a Chi-square test and a p<0.05 was considered significant.

RESULTS

Of the total 1116 segments (= or >2 mm lumen diameter), 173 presented significant stenosis. The sensitivity and specificity for the assessment of significant stenosis were 89.4% and 93.3% vs 94.3% and 97.4% in the presence of increasing intravascular enhancement, 92.8% and 96.7% vs 91.1% and 93.9% in the presence of increasing heart rate, and 89.7% and 97.6% vs 93.3% and 92,8% in the presence of an increasing calcium score.

CONCLUSIONS

Increasing intravascular enhancement significantly improves diagnostic accuracy in MSCT-CA. A higher heart rate lowers the specificity in the detection of significant obstructing lesions of the coronary artery. An increasing calcium score determines a lower specificity and a higher sensitivity.

摘要

目的

评估血管内强化、心率及钙化积分对使用16排多层螺旋CT（MSCT）检测显著冠状动脉狭窄诊断准确性的影响。

材料与方法

回顾性纳入100例疑似冠心病患者（88例男性；年龄59±11岁），这些患者均接受了传统冠状动脉造影（CA）和MSCT冠状动脉造影（MSCT-CA）检查。患者接受MSCT-CA检查，扫描方案如下：准直16×0.75mm，机架旋转时间420ms，每旋转进床速度2.8mm，管电压120kV，管电流400-500mAs。造影剂注射方案为以4ml/s的速度注射100ml碘克沙醇320mgI/ml，并采用团注追踪技术确定扫描延迟时间。对所有患者在主动脉根部以及左右冠状动脉测量血管强化情况。根据平均血管强化程度将患者分为两组，每组50例，一组强化程度较低（低强化组），另一组强化程度较高（高强化组）。以定量CA作为参考标准，在两组中评估直径≥2mm血管段检测显著狭窄（管腔直径减少≥50%）的诊断准确性（按冠状动脉节段）。采用卡方检验比较诊断准确性的差异，p<0.05认为具有统计学意义。

结果

在总共1116个血管段（管腔直径≥2mm）中，173个存在显著狭窄。在血管内强化程度增加时，评估显著狭窄的敏感性和特异性分别为89.4%和93.3%，而在强化程度更高时分别为94.3%和97.4%；在心率增加时，敏感性和特异性分别为92.8%和96.7%，而在心率更高时分别为91.1%和93.9%；在钙化积分增加时，敏感性和特异性分别为89.7%和97.6%，而在钙化积分更高时分别为93.3%和92.8%。