Bonmassari Roberto, Muraglia Simone, Centonze Maurizio, Coser Daniela, Stoppa Gabriele, Disertori Marcello
Cardiology Department, S. Chiara Hospital, Trento, Italy.
J Cardiovasc Med (Hagerstown). 2006 Nov;7(11):817-25. doi: 10.2459/01.JCM.0000250870.55907.75.
To evaluate the feasibility and accuracy of 16-slice spiral computed tomography (MSCT) in detecting coronary artery lesions in a low to moderate risk population.
MSCT was performed in 33/78 patients at low to moderate risk for coronary artery disease affected by mitral and/or aortic valve disease and scheduled for conventional coronary angiography for pre-surgery evaluation. The sensitivity (SE), specificity (SP), positive (PPV) and negative predictive values (NPV) to identify >or=50% obstructed lesions were evaluated. Moreover, a discriminant predictive statistical analysis was performed.
MSCT visualised 428/479 (89%) segments identified at coronary angiography and the percentage of evaluable segments was 87%. By including all coronary branches, SE, SP, PPV and NPV were 69%, 96%, 58% and 97%, respectively. By excluding the segments with a diameter of <or=2 mm, SE and SP were 74% and 96%, respectively (MSCT correctly identified 17/23 lesions). In the evaluable coronary arteries, SE and SP were 86% and 88% for the left anterior descending coronary artery, 100% and 85% for the left circumflex coronary artery, and 86% and 89% for the right coronary artery, respectively. SP was 100% for the left main artery. When restricting the analysis to the patients, 22/23 patients were adequately evaluable, and SE, SP, PPV and NPV were 100%, 80%, 85% and 100%, respectively. Using the discriminant predictive statistical analysis of quantitative (age, heart rate and calcium score) and qualitative variables (presence or absence of critical lesions at MSCT), an overall accuracy of 85% was obtained.
The percentage of adequately evaluable patients was low because of limitations due to calcifications. In selected populations at low to moderate risk for coronary artery disease, MSCT has a high NPV in the evaluation of coronary artery stenosis.
评估16层螺旋计算机断层扫描（MSCT）在低至中度风险人群中检测冠状动脉病变的可行性和准确性。
对33/78例因二尖瓣和/或主动脉瓣疾病而处于低至中度冠状动脉疾病风险且计划进行传统冠状动脉造影以进行术前评估的患者进行MSCT检查。评估识别≥50%阻塞性病变的敏感性（SE）、特异性（SP）、阳性预测值（PPV）和阴性预测值（NPV）。此外，进行了判别预测统计分析。
MSCT显示了冠状动脉造影中识别出的428/479（89%）个节段，可评估节段的百分比为87%。纳入所有冠状动脉分支后，SE、SP、PPV和NPV分别为69%、96%、58%和97%。排除直径≤2mm的节段后，SE和SP分别为74%和96%（MSCT正确识别了17/23个病变）。在可评估的冠状动脉中，左前降支冠状动脉的SE和SP分别为86%和88%，左旋支冠状动脉的SE和SP分别为100%和85%，右冠状动脉的SE和SP分别为86%和89%。左主干动脉的SP为100%。将分析局限于患者时，22/23例患者可充分评估，SE、SP、PPV和NPV分别为100%、80%、85%和100%。使用定量（年龄、心率和钙化积分）和定性变量（MSCT时是否存在关键病变）的判别预测统计分析，总体准确率为85%。
由于钙化的限制，可充分评估患者的比例较低。在选定的低至中度冠状动脉疾病风险人群中，MSCT在评估冠状动脉狭窄方面具有较高的NPV。
