Cornily Jean-Christophe, Gilard Martine, Le Gal Grégoire, Pennec Pierre-Yves, Vinsonneau Ulric, Blanc Jean-Jacques, Mansourati Jacques, Boschat Jacques
Department of Cardiology, Brest University Hospital, France.
Eur J Radiol. 2007 Jan;61(1):84-90. doi: 10.1016/j.ejrad.2006.08.010. Epub 2006 Sep 20.
Multislice Computed Tomography (MSCT) recently proved its accuracy in the detection of coronary artery disease (CAD). It can also give information about left ventricular function and venous network anatomy. We here sought to validate a MSCT-based strategy in the initial evaluation of patients with dilated cardiomyopathy (DCM).
36 patients with DCM underwent cardiac MSCT before conventional coronary angiography with ventriculography. We analysed arterial calcium score (Agatston score equivalent: ASE), coronary stenosis, left ventricular parameters and venous network.
The sensitivity of a MSCT-based strategy in detecting significant CAD was 100% and the specificity 80%. The positive and negative predictive values were respectively 67% and 100%. For ASE <1.000 (75% of patients), MSCT detected all non-CAD patients without one (motion artifacts), enabling conventional angiography to be avoided in 21/27 patients (77.7%). For ASE > or =1000, MSCT enabled conventional angiography to be avoided in only 2/9 patients (22.2%). The ventricle was assessable in 83.4% (30 patients) on MSCT. Correlation coefficient Rs with ventriculography were 0.78 (p<0.0001), 0.77 (p<0.0001) and 0.82 (p<0.0001) respectively for end-diastolic volume, end-systolic volume and EF. The venous network was assessable in all patients both on MSCT and angiography.
In patients undergoing an initial evaluation of DCM, MSCT appears to be an effective alternative to conventional angiography. The following attitude may be proposed: when ASE >1.000, conventional coronary angiography is mandatory due to MSCT's poor interest in such cases; when ASE <1.000, a contrast-enhanced MSCT may, when normal, replace coronary angiography.
多层螺旋计算机断层扫描（MSCT）最近在冠状动脉疾病（CAD）检测中证明了其准确性。它还能提供有关左心室功能和静脉网络解剖结构的信息。我们在此试图验证基于MSCT的策略在扩张型心肌病（DCM）患者初始评估中的有效性。
36例DCM患者在进行常规冠状动脉造影及心室造影前接受了心脏MSCT检查。我们分析了动脉钙化评分（等效阿加斯顿评分：ASE）、冠状动脉狭窄、左心室参数和静脉网络。
基于MSCT的策略检测显著CAD的敏感性为100%，特异性为80%。阳性和阴性预测值分别为67%和100%。对于ASE<1000（75%的患者），MSCT检测出所有非CAD患者且无一例（运动伪影）漏诊，使得21/27例患者（77.7%）无需进行常规血管造影。对于ASE≥1000，MSCT仅使2/9例患者（22.2%）无需进行常规血管造影。MSCT上83.4%（30例患者）的心室可评估。舒张末期容积、收缩末期容积和射血分数与心室造影的相关系数Rs分别为0.78（p<0.0001）、0.77（p<0.0001）和0.82（p<0.0001）。MSCT和血管造影在所有患者中均能评估静脉网络。
在对DCM患者进行初始评估时，MSCT似乎是常规血管造影的有效替代方法。可提出以下策略：当ASE>1000时，由于MSCT对此类病例价值不大，常规冠状动脉造影必不可少；当ASE<1000时，增强MSCT结果正常时可替代冠状动脉造影。
