Gaemperli Oliver, Schepis Tiziano, Koepfli Pascal, Valenta Ines, Soyka Jan, Leschka Sebastian, Desbiolles Lotus, Husmann Lars, Alkadhi Hatem, Kaufmann Philipp A
Nuclear Cardiology, Cardiovascular Center, University Hospital Zurich NUK C 40, Raemistrasse 100, 8091 Zurich, Switzerland.
Eur J Nucl Med Mol Imaging. 2007 Aug;34(8):1162-71. doi: 10.1007/s00259-006-0307-z. Epub 2007 Jan 12.
CT angiography (CTA) offers a valuable alternative for the diagnosis of CAD but its value in the detection of functionally relevant coronary stenoses remains uncertain. We prospectively compared the accuracy of 64-slice CTA with that of myocardial perfusion imaging (MPI) using (99m)Tc-tetrofosmin-SPECT as the gold standard for the detection of functionally relevant coronary artery disease (CAD).
MPI and 64-slice CT were performed in 100 consecutive patients. CTA lesions were analysed quantitatively and area stenoses > or =50% and > or =75% were compared with the MPI findings.
In 23 patients, MPI perfusion defects were found (12 reversible, 13 fixed). A total of 399 coronary arteries and 1,386 segments was analysed. Eighty-four segments (6.1%) in 23 coronary arteries (5.8%) of nine patients (9.0%) were excluded owing to insufficient image quality. In the remaining 1,302 segments, quantitative CTA revealed stenoses > or =50% in 57 of 376 coronary arteries (15.2%) and stenoses > or =75% in 32 (8.5%) coronary arteries. Using a cut-off at > or =75% area stenosis, CTA yielded the following sensitivity, specificity, negative (NPV) and positive predictive value (PPV), and accuracy for the detection of any (fixed and reversible) MPI defect: by patient, 75%, 90%, 93%, 68% and 87%, respectively; by artery, 76%, 95%, 99%, 50% and 94%, respectively.
Sixty-four-slice CTA is a reliable tool to rule out functionally relevant CAD in a non-selected population with an intermediate pretest likelihood of disease. However, an abnormal CTA is a poor predictor of ischaemia.
CT血管造影（CTA）为冠心病（CAD）的诊断提供了一种有价值的替代方法，但其在检测功能相关冠状动脉狭窄方面的价值仍不确定。我们前瞻性地比较了64层CTA与心肌灌注成像（MPI）的准确性，以（99m）锝-替曲膦单光子发射计算机断层扫描（SPECT）作为检测功能相关冠状动脉疾病（CAD）的金标准。
对100例连续患者进行MPI和64层CT检查。对CTA病变进行定量分析，并将面积狭窄≥50%和≥75%的情况与MPI结果进行比较。
23例患者发现MPI灌注缺损（12例可逆，13例固定）。共分析了399支冠状动脉和1386个节段。由于图像质量不足，9例患者（9.0%）的23支冠状动脉（5.8%）中的84个节段（6.1%）被排除。在其余1302个节段中，定量CTA显示376支冠状动脉中有57支（15.2%）存在≥50%的狭窄，32支（8.5%）冠状动脉存在≥75%的狭窄。以面积狭窄≥75%为界值，CTA对检测任何（固定和可逆）MPI缺损的敏感性、特异性、阴性预测值（NPV）和阳性预测值（PPV）以及准确性如下：按患者计算，分别为75%、90%、93%、68%和87%；按动脉计算，分别为76%、95%
