无创计算机断层扫描血管造影术在评估冠状动脉支架通畅性中的应用：澳大利亚的经验

Non-invasive computed tomography angiography in the assessment of coronary stent patency: an Australian experience.

作者信息

Soon K H, Cox N, Chaitowitz I, Selvanayagam J B, Farouque O, MacGregor L, Bell K W, Lim Y L

机构信息

Centre for Cardiovascular Therapeutics, Western Hospital, Melbourne, Victoria, Australia.

出版信息

Intern Med J. 2007 Jun;37(6):360-4. doi: 10.1111/j.1445-5994.2007.01363.x.

DOI:10.1111/j.1445-5994.2007.01363.x

PMID:17535378

Abstract

BACKGROUND

This study aimed to evaluate the feasibility and accuracy of 16-slice computed tomography (CT) in the assessment of coronary stent patency. CT coronary angiography (CA) has a high degree of accuracy in the assessment of coronary artery disease compared with invasive selective CA. However, its accuracy in the evaluation of stent patency is not well investigated.

METHODS

We conducted a retrospective observational study of paired CT coronary angiography (CT-CA) and invasive fluoroscopic coronary angiography (FCA) in 37 patients with 47 coronary stents. CT-CA was carried out with an electrocardiogram-gated 16-slice CT (LightSpeed-16, General Electric (GE), WI, USA). Two CT reporters, blinded to the FCA findings, assessed CT images for stent patency. A cardiologist blinded to CT findings reported FCA. FCA was regarded as the reference standard.

RESULTS

A CT-CA could assess 45 of 47 coronary stents (96%). Non-assessable stents on CT-CA were due to motion artefacts and stent-blooming effects. Of those 45 assessable stents, CT-CA correctly identified five out of seven stents with binary in-stent restenosis (ISR) and 37 of 38 stents without binary ISR. The sensitivity and specificity of 16-slice CT in the evaluation of coronary stents for binary ISR were 71% (95% confidence interval (CI) (29%, 96%)) and 97% (95%CI (86%, 100%)), respectively, exclusive of non-assessable stents. The positive and negative predictive values of 16-slice CT were 83% (95%CI (36%, 100%)) and 95% (95%CI (83%, 99%)), respectively.

CONCLUSION

Sixteen-slice CT has a low sensitivity, but very a high specificity when compared with FCA in the evaluation of coronary stents for ISR.

摘要

背景

本研究旨在评估16层计算机断层扫描（CT）在评估冠状动脉支架通畅性方面的可行性和准确性。与有创选择性冠状动脉造影相比，CT冠状动脉造影（CA）在评估冠状动脉疾病方面具有高度准确性。然而，其在评估支架通畅性方面的准确性尚未得到充分研究。

方法

我们对37例患者的47个冠状动脉支架进行了配对CT冠状动脉造影（CT-CA）和有创荧光透视冠状动脉造影（FCA）的回顾性观察研究。CT-CA采用心电图门控16层CT（LightSpeed-16，通用电气（GE），美国威斯康星州）进行。两名对FCA结果不知情的CT报告员评估CT图像以确定支架通畅性。一名对CT结果不知情的心脏病专家报告FCA情况。FCA被视为参考标准。

结果

CT-CA能够评估47个冠状动脉支架中的45个（96%）。CT-CA上不可评估的支架是由于运动伪影和支架伪像效应。在这45个可评估的支架中，CT-CA正确识别出7个存在二元性支架内再狭窄（ISR）的支架中的5个，以及38个不存在二元性ISR的支架中的37个。排除不可评估的支架后，16层CT在评估冠状动脉支架二元性ISR方面的敏感性和特异性分别为71%（95%置信区间（CI）（29%，96%））和97%（95%CI（86%，100%））。16层CT的阳性和阴性预测值分别为83%（95%CI（36%，100%））和95%（95%CI（83%，99%））。