Leber Alexander W, Becker Alexander, Knez Andreas, von Ziegler Franz, Sirol Marc, Nikolaou Konstantin, Ohnesorge Bernd, Fayad Zahi A, Becker Christoph R, Reiser Maximilian, Steinbeck Gerhard, Boekstegers Peter
Department of Cardiology, Klinikum Grosshadern, University of Munich, Munich, Germany.
J Am Coll Cardiol. 2006 Feb 7;47(3):672-7. doi: 10.1016/j.jacc.2005.10.058. Epub 2006 Jan 6.
We evaluated the accuracy of a new 64-slice computed tomography (CT) scanner, compared with intravascular ultrasound, to visualize atherosclerosis in the proximal coronary system.
Noninvasive determination of plaque composition and plaque burden may be important to improve risk stratification.
In 20 patients, a 64-slice CT scan (Sensation 64, Siemens Medical Solutions, Forchheim, Germany) and an intravascular ultrasound investigation of vessels without stenosis >50% was performed. Diagnostic image quality with 64-slice CT was obtained in 36 vessels in 19 patients.
In these vessels, which were divided in 3-mm sections, 64-slice CT enabled a correct detection of plaque in 54 of 65 (83%) sections containing noncalcified plaques, 50 of 53 (94%) sections containing mixed plaques, and 41 of 43 (95%) sections containing calcified plaques. In 192 of 204 (94%) sections, atherosclerotic lesions were excluded correctly. In addition, 64-slice CT enabled the visualization of 7 of 10 (70%) sections revealing a lipid pool and could identify a spotty calcification pattern in 27 of 30 (90%) sections. The correlation coefficient to determine plaque volumes per vessel was r2 = 0.69 (p < 0.001) with an underestimation of mixed and noncalcified plaque volumes (p < 0.03) and a trend to overestimate calcified plaque volumes by 64-slice CT. The interobserver variability to determine plaque volumes was 37%. Interobserver agreement to identify atherosclerotic sections was good (Cohen's kappa coefficient = 0.75).
We conclude that 64-slice CT reveals encouraging results to noninvasively detect different types of coronary plaques located in the proximal coronary system. The ability to determine plaque burden currently is hampered by mainly an insufficient reproducibility.
我们评估了一款新型64层计算机断层扫描（CT）扫描仪与血管内超声相比，在显示冠状动脉近端系统动脉粥样硬化方面的准确性。
无创测定斑块成分和斑块负荷对于改善风险分层可能很重要。
对20例患者进行了64层CT扫描（Sensation 64，西门子医疗解决方案公司，德国福希海姆）以及对狭窄程度>50%的血管进行血管内超声检查。19例患者的36条血管获得了64层CT的诊断图像质量。
在这些被分成3毫米节段的血管中，64层CT能够在65个包含非钙化斑块的节段中的54个（83%）、53个包含混合斑块的节段中的50个（94%）以及43个包含钙化斑块的节段中的41个（95%）正确检测到斑块。在204个节段中的192个（94%）节段中，正确排除了动脉粥样硬化病变。此外，64层CT能够在10个显示脂质池的节段中的7个（70%）中观察到脂质池，并能在30个节段中的27个（90%）中识别出斑点状钙化模式。确定每条血管斑块体积的相关系数为r2 = 0.69（p < 0.001），64层CT对混合斑块和非钙化斑块体积有低估（p < 0.03），对钙化斑块体积有高估趋势。观察者间确定斑块体积的变异性为37%。观察者间识别动脉粥样硬化节段的一致性良好（科恩kappa系数 = 0.75）。
我们得出结论，64层CT在无创检测位于冠状动脉近端系统的不同类型冠状动脉斑块方面显示出令人鼓舞的结果。目前，确定斑块负荷的能力主要受到重复性不足的阻碍。
