Nishida Chikako, Okajima Kaoru, Kudo Takashi, Yamamoto Takashi, Hattori Ryuichi, Nishimura Yasumasa
Department of Radiology, Nara Hospital, Kinki University School of Medicine, Otoda-cho 1248-1, Ikoma, Nara 630-0293, Japan.
Ann Nucl Med. 2005 Dec;19(8):647-53. doi: 10.1007/BF02985112.
To examine whether we could predict myocardial ischemia when coronary artery calcification is detected by non-gated multidetector CT in patients with suspected ischemic heart disease.
Eighty-three patients suspected of having ischemic heart disease (55 men, 28 women; age range 36-83 years; mean age 68 years) underwent multidetector CT and T1-201 single photon emission computed tomography. Prediction of myocardial ischemia by coronary arterial calcification detected on CT was evaluated by comparing the coronary artery territories that showed calcification with the area of myocardial ischemia determined by SPECT. The sensitivity, specificity, positive predictive value, and negative predictive value of multidetector CT for predicting myocardial ischemia were calculated. Coronary angiography was also examined and compared with multidetector CT. Risk factors, including hypertension, smoking, hyperlipidemia, diabetes, and family history, were compared for evidence of coronary artery calcification detected by multidetector CT and myocardial ischemia detected by thallium nuclear scans.
For analysis by patients, the sensitivity, specificity, positive predictive value, and negative predictive value of coronary artery calcification for myocardial ischemia detection were 65, 63, 56, and 71%, respectively. Similarly, for analysis by coronary arterial territories, those values were 56, 77, 41 and 86%, respectively. Coronary stenosis on CAG was also related to the ischemia determined by SPECT and calcification on multidetector CT. Ischemia was better influenced by risk factors than was coronary arterial calcification.
For analysis by coronary arterial territories, the specificity and negative predictive value of coronary arterial calcification seen by multidetector CT are relatively high.
探讨在疑似缺血性心脏病患者中，通过非门控多层螺旋CT检测到冠状动脉钙化时，能否预测心肌缺血。
83例疑似缺血性心脏病患者（55例男性，28例女性；年龄范围36 - 83岁；平均年龄68岁）接受了多层螺旋CT和T1 - 201单光子发射计算机断层扫描。通过比较CT上显示钙化的冠状动脉区域与SPECT确定的心肌缺血区域，评估CT检测到的冠状动脉钙化对心肌缺血的预测能力。计算多层螺旋CT预测心肌缺血的敏感性、特异性、阳性预测值和阴性预测值。还对冠状动脉造影进行了检查并与多层螺旋CT进行比较。比较包括高血压、吸烟、高脂血症、糖尿病和家族史在内的危险因素，以寻找多层螺旋CT检测到的冠状动脉钙化和铊核素扫描检测到的心肌缺血的证据。
以患者为分析单位时，冠状动脉钙化检测心肌缺血的敏感性、特异性、阳性预测值和阴性预测值分别为65%、63%、56%和71%。同样，以冠状动脉区域为分析单位时，这些值分别为56%、77%、41%和86%。冠状动脉造影上的冠状动脉狭窄也与SPECT确定的缺血和多层螺旋CT上的钙化有关。缺血比冠状动脉钙化受危险因素的影响更大。
以冠状动脉区域为分析单位时，多层螺旋CT所见冠状动脉钙化的特异性和阴性预测值相对较高。
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