社区医院中16排多层螺旋计算机断层扫描非侵入性冠状动脉造影的有限实用性。

Limited usefulness of non-invasive coronary angiography with 16-detector multislice computer tomography at a community hospital.

作者信息

Rødevand Olaf, Høgalmen Geir, Gudim Lars Petter, Indrebø Tor, Mølstad Per, Vandvik Per Olav

机构信息

Department of Cardiology, Feiring Heart Clinic, Norway.

出版信息

Scand Cardiovasc J. 2006 Apr;40(2):76-82. doi: 10.1080/14017430600686969.

DOI:10.1080/14017430600686969

PMID:16608776

Abstract

OBJECTIVES

To evaluate the usefulness of coronary angiography by 16-detector multislice spiral computed tomography (MSCT) in community hospital outpatients.

DESIGN

MSCT was performed at the community hospital in 157 of 218 consecutive outpatients with suspected significant coronary disease, before referral for invasive coronary angiography.

RESULTS

101 patients had interpretable MSCT angiograms (64 men, age 62+/-10 years, calcium score 373+/-678, heart rate 56+/-7 beats/min, beta-blocker used by 91%). Coronary stenoses >50% were identified by invasive angiography in 49 patients. Only 79% of all segments could be assessed by MSCT due to heavy coronary calcification (12%) and blurred images (9%) in the remaining. By interpreting non-assessable segments as negative results 79 patients were correctly classified by MSCT. Sensitivity, specificity, positive and negative predictive values at patient level was 82%, 75%, 75% and 81%. By interpreting non-assessable segments as positive findings, the corresponding values were 100%, 29%, 57% and 100%, with correct diagnoses in 63% of patients.

CONCLUSIONS

Limited diagnostic accuracy, non-interpretable scans and radiation exposure restrict the usefulness of coronary MSCT in a community hospital setting.

摘要

目的

评估16排多层螺旋计算机断层扫描（MSCT）冠状动脉造影在社区医院门诊患者中的应用价值。

设计

在一家社区医院，对218例连续的疑似患有严重冠状动脉疾病的门诊患者中的157例进行了MSCT检查，这些患者随后接受了有创冠状动脉造影检查。

结果

101例患者的MSCT血管造影图像可用于分析（64例男性，年龄62±10岁，钙化积分373±678，心率56±7次/分钟，91%的患者使用了β受体阻滞剂）。有创血管造影显示49例患者存在>50%的冠状动脉狭窄。由于严重的冠状动脉钙化（12%）和其余患者图像模糊（9%），MSCT仅能评估所有节段的79%。将不可评估节段解释为阴性结果时，MSCT正确分类了79例患者。在患者层面，敏感性、特异性、阳性预测值和阴性预测值分别为82%、75%、75%和81%。将不可评估节段解释为阳性结果时，相应的值分别为100%、29%、57%和100%，63%的患者诊断正确。