Ferencik Maros, Ropers Dieter, Abbara Suhny, Cury Ricardo C, Hoffmann Udo, Nieman Koen, Brady Thomas J, Moselewski Fabian, Daniel Werner G, Achenbach Stephan
Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
Radiology. 2007 Jun;243(3):696-702. doi: 10.1148/radiol.2433060080.
To retrospectively evaluate the diagnostic accuracy of multidetector computed tomography (CT) coronary angiography for detection of hemodynamically significant (>or=50%) stenoses by using various image postprocessing methods, with conventional coronary angiography as the reference standard.
The analysis used data from previous studies, use of which had been approved by the Institutional Review Board. Sixteen-section multidetector CT data sets for 40 patients (30 men, 10 women; mean age 56 years +/- 8; mean heart rate, 61 beats per minute +/- 6) were evaluated. Six independent investigators evaluated the data sets for the presence of stenoses with diameter reduction of 50% or more, by using either exclusively transverse images, free oblique multiplanar reconstructions (MPRs), free oblique maximum intensity projections (MIPs, 5 mm thick), prerendered curved MPRs, prerendered curved MIPs, or prerendered three-dimensional volume rendered reconstructions (VRTs). Evaluation results were compared with conventional coronary angiography for each artery in a blinded fashion (chi(2) test).
Overall, 35 coronary artery stenoses were present. Percentage of evaluable arteries and accuracy for detecting stenosis (percentages of accurately classified arteries were, respectively, 99% and 88% for transverse, 99% and 91% for oblique MPR, 94% and 86% for oblique MIP, 94% and 83% for curved MIP, 93% and 81% for curved MPR, and 91% and 73% for VRT). Accuracy was significantly higher for oblique MPR than for curved MPR (P=.01), curved MIP (P=.03), and VRT (P<.001).
The evaluation of multidetector CT coronary angiography with interactive image display methods, especially interactive oblique MPRs, permits higher diagnostic accuracy than evaluation of prerendered images (curved MPR, curved MIP, or VRT images).
以传统冠状动脉造影为参考标准，回顾性评估多排螺旋计算机断层扫描（CT）冠状动脉造影术通过各种图像后处理方法检测血流动力学显著狭窄（≥50%）的诊断准确性。
分析使用先前研究的数据，其使用已获机构审查委员会批准。对40例患者（30例男性，10例女性；平均年龄56岁±8岁；平均心率61次/分钟±6次）的16排多排螺旋CT数据集进行评估。6名独立研究人员通过仅使用横断图像、任意倾斜多平面重建（MPR）、任意倾斜最大密度投影（MIP，层厚5mm）、预渲染曲面MPR、预渲染曲面MIP或预渲染三维容积再现重建（VRT）评估数据集是否存在直径缩小50%或更多的狭窄。以盲法（卡方检验）将各动脉的评估结果与传统冠状动脉造影进行比较。
总体上，存在35处冠状动脉狭窄。可评估动脉的百分比及检测狭窄的准确性（横断图像准确分类动脉的百分比分别为99%和88%，倾斜MPR为99%和91%，倾斜MIP为94%和86%，曲面MIP为94%和83%，曲面MPR为93%和81%，VRT为91%和73%）。倾斜MPR的准确性显著高于曲面MPR（P = 0.01）、曲面MIP（P = 0.03）和VRT（P < 0.001）。
与预渲染图像（曲面MPR、曲面MIP或VRT图像）评估相比，采用交互式图像显示方法（尤其是交互式倾斜MPR）对多排螺旋CT冠状动脉造影进行评估可获得更高的诊断准确性。
