Schlosser T, Mohrs O K, Magedanz A, Nowak B, Voigtländer T, Barkhausen J, Schmermund A
Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany.
Acta Radiol. 2007 Apr;48(3):300-7. doi: 10.1080/02841850701203587.
To evaluate the value of 64-detector-row computed tomography for ruling out high-grade coronary stenoses in patients with a low to moderate pretest probability of significant coronary artery disease.
The study included 61 patients with a suspicion of coronary artery disease on the basis of atypical angina or ambiguous findings in noninvasive stress testing and a class II indication for invasive coronary angiography (ICA). All patients were examined by 64-detector-row computed tomography angiography (CTA) and ICA. On a coronary segmental level, the presence of significant (> or = 50% diameter) stenoses was examined.
In a total of 915 segments, CTA detected 62 significant stenoses. Thirty-four significant stenoses were confirmed by ICA, whereas 28 stenoses could not be confirmed by ICA. Twenty-two of them showed wall irregularities on ICA, and six were angiographically normal. Accordingly, on a coronary segmental basis, 28 false-positive and 0 false-negative findings resulted in a sensitivity of 100%, a specificity of 96.8%, a positive predictive value of 54.8%, and a negative predictive value of 100%. The diagnostic accuracy was 96.9%.
Sixty-four-detector-row computed tomography reliably detects significant coronary stenoses in patients with suspected coronary artery disease and appears to be helpful in the selection of patients who need to undergo ICA. Calcified and non-calcified plaques are detected. Grading of stenoses in areas with calcification is difficult. Frequently, stenosis severity is overestimated by 64-detector-row computed tomography.
评估64排计算机断层扫描在排除冠心病患病可能性为低到中度的患者中高级别冠状动脉狭窄方面的价值。
本研究纳入61例基于非典型心绞痛或无创负荷试验中不明确结果而疑似冠心病且有进行有创冠状动脉造影（ICA）II类指征的患者。所有患者均接受64排计算机断层扫描血管造影（CTA）和ICA检查。在冠状动脉节段水平上，检查是否存在显著（直径≥50%）狭窄。
在总共915个节段中，CTA检测到62处显著狭窄。34处显著狭窄经ICA证实，而28处狭窄未被ICA证实。其中22处ICA显示管壁不规则，6处血管造影正常。因此，在冠状动脉节段基础上，28例假阳性和0例假阴性结果导致敏感性为100%，特异性为96.8%，阳性预测值为54.8%，阴性预测值为100%。诊断准确性为96.9%。
64排计算机断层扫描能可靠地检测出疑似冠心病患者中的显著冠状动脉狭窄，似乎有助于筛选需要进行ICA的患者。能检测出钙化和非钙化斑块。钙化区域的狭窄分级困难。64排计算机断层扫描常常高估狭窄严重程度。
