多层螺旋CT在疾病严重程度预测试验可能性较低的患者冠状动脉疾病诊断中的临床价值

Clinical value of MDCT in the diagnosis of coronary artery disease in patients with a low pretest likelihood of significant disease.

作者信息

Nikolaou Konstantin, Rist Carsten, Wintersperger Bernd J, Jakobs Tobias F, van Gessel Roland, Kirchin Miles A, Knez Andreas, von Ziegler Franz, Reiser Maximilian F, Becker Christoph R

机构信息

Department of Clinical Radiology, University Hospitals-Grosshadern, Ludwig-Maximilians University of Munich, Grosshadern Campus, Marchioninistr. 15, Munich 81377, Germany.

出版信息

AJR Am J Roentgenol. 2006 Jun;186(6):1659-68. doi: 10.2214/AJR.05.0726.

DOI:10.2214/AJR.05.0726

PMID:16714656

Abstract

OBJECTIVE

The aim of this study was to evaluate the clinical value of MDCT in the diagnosis of coronary artery disease in a population having a low pretest likelihood of significant disease.

SUBJECTS AND METHODS

Sixty-four patients with suspected coronary artery disease and a low pretest likelihood of significant disease according to the criteria of the American Heart Association underwent both MDCT of the heart and quantitative conventional coronary angiography (QCA). MDCT examinations were performed on a 16-MDCT scanner. CT data sets were evaluated on a per-patient basis and a per-segment basis and were classified as indicating no disease, nonsignificant disease (stenoses </= 50%), or significant disease (stenoses > 50%). Sensitivity, specificity, negative predictive value (NPV), and positive predictive value (PPV) of 16-MDCT in the detection or exclusion of significant and nonsignificant coronary artery disease were evaluated on both per-patient and per-segment bases.

RESULTS

Regarding the success rate of 16-MDCT, 94% (60/64) of patients and 92% (388/420) of vessel segments were of sufficient quality for diagnosis. In the remaining 60 patients evaluated, QCA revealed significant coronary artery disease, nonsignificant disease, and no disease in 8.3% (5/60), 75.0% (45/60), and 16.7% (10/60) of cases, respectively, on a per-patient basis, and in 1.3% (5/388), 23.2% (90/388), and 75.5% (293/388) of cases, respectively, on a per-segment basis. The sensitivity, specificity, NPV, and PPV of 16-MDCT for the detection of significant coronary artery disease were 80.0%, 94.5%, 98.1%, and 57.1%, respectively, on a per-patient basis, and 80.0%, 99.2%, 99.7%, and 57.1% on a per-segment basis.

CONCLUSION

In a population having a low pretest likelihood of significant coronary artery disease, 16-MDCT shows a moderate to high sensitivity and high NPV for the detection or exclusion of significant disease, but has a somewhat reduced PPV compared with QCA.

摘要

目的

本研究旨在评估多层螺旋CT（MDCT）在诊断重大疾病预测试可能性较低人群的冠状动脉疾病中的临床价值。

对象与方法

64例疑似冠状动脉疾病且根据美国心脏协会标准重大疾病预测试可能性较低的患者接受了心脏MDCT检查和定量传统冠状动脉造影（QCA）。MDCT检查在16层MDCT扫描仪上进行。CT数据集按每位患者和每个节段进行评估，并分类为无疾病、非重大疾病（狭窄≤50%）或重大疾病（狭窄>50%）。在每位患者和每个节段的基础上评估16层MDCT检测或排除重大和非重大冠状动脉疾病的敏感性、特异性、阴性预测值（NPV）和阳性预测值（PPV）。

结果

关于16层MDCT的成功率，94%（60/64）的患者和92%（388/420）的血管节段质量足以进行诊断。在其余评估的60例患者中，QCA显示，按每位患者计算，重大冠状动脉疾病、非重大疾病和无疾病分别占8.3%（5/60）、75.0%（45/60）和16.7%（10/60）的病例，按每个节段计算，分别占1.3%（5/388）、23.2%（90/388）和75.5%（293/388）的病例。16层MDCT检测重大冠状动脉疾病的敏感性、特异性、NPV和PPV，按每位患者计算分别为80.0%、94.5%、98.1%和57.1%，按每个节段计算分别为80.0%、99.2%、99.7%和57.1%。