Pugliese Francesca, Mollet Nico R, Hunink M G Myriam, Cademartiri Filippo, Nieman Koen, van Domburg Ron T, Meijboom Willem B, Van Mieghem Carlos, Weustink Annick C, Dijkshoorn Marcel L, de Feyter Pim J, Krestin Gabriel P
Department of Radiology, Erasmus MC University Medical Center Rotterdam, Dr Molewaterplein 40, 3015GD Rotterdam, the Netherlands.
Radiology. 2008 Feb;246(2):384-93. doi: 10.1148/radiol.2462070113. Epub 2008 Jan 7.
To retrospectively compare sensitivity and specificity of four generations of multidetector computed tomographic (CT) scanners for diagnosing significant (>or=50%) coronary artery stenosis, with quantitative conventional coronary angiography as reference standard.
The institutional review board approved this study. All patients consented to undergo CT studies prior to conventional coronary angiography, after they were informed of the additional radiation dose, and to the use of their data for future retrospective research. Two hundred four patients (157 men, 47 women; mean age, 58 years +/- 11 [standard deviation]), classified in four groups of 51 patients each, underwent coronary CT angiography with four-section, first- and second-generation 16-section, and 64-section CT scanners. Patients in sinus rhythm scheduled for conventional coronary angiography (stable angina, atypical chest pain) were included. Patients with bypass grafts and stents were excluded. Two readers unaware of results of conventional coronary angiography evaluated CT scans. Coronary artery segments of 2 mm or larger in diameter were included for comparative evaluation with quantitative coronary angiography. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) for detection of significant stenoses (>or=50% luminal diameter reduction) were calculated.
Image quality was rated poor for the following percentages of coronary artery segments: 33.1% at four-section CT, 14.4% at first-generation 16-section CT, 6.3% at second-generation 16-section CT, and 2.6% at 64-section CT. Sensitivity, specificity, PPV, and NPV, respectively, were as follows: 57%, 91%, 60%, and 90% at four-section CT; 90%, 93%, 65%, and 99% at first-generation 16-section CT; 97%, 98%, 87%, and 100% at second-generation 16-section CT; and 99%, 96%, 80%, and 100% at 64-section CT. Diagnostic performance of four-section CT was significantly poorer than that of second-generation 16-section CT (odds ratio = 4.57) and 64-section CT (odds ratio = 2.89).
Diagnostic performance of coronary CT angiography varies among scanners of different generations. Earlier-generation scanners (four sections) had significantly poorer performance; performance of 16- compared with 64-section CT scanners showed progressive, although not significant, improvement.
以定量传统冠状动脉造影为参考标准，回顾性比较四代多排螺旋计算机断层扫描（CT）扫描仪诊断显著（≥50%）冠状动脉狭窄的敏感性和特异性。
机构审查委员会批准了本研究。所有患者在被告知额外辐射剂量后，同意在进行传统冠状动脉造影之前接受CT检查，并同意将其数据用于未来的回顾性研究。204例患者（157例男性，47例女性；平均年龄58岁±11[标准差]），分为四组，每组51例，分别使用四排、第一代和第二代16排以及64排CT扫描仪进行冠状动脉CT血管造影。纳入计划进行传统冠状动脉造影（稳定型心绞痛、非典型胸痛）的窦性心律患者。排除有搭桥移植和支架的患者。两名不知传统冠状动脉造影结果的阅片者对CT扫描进行评估。纳入直径2mm或更大的冠状动脉节段，与定量冠状动脉造影进行比较评估。计算检测显著狭窄（管腔直径减少≥50%）的敏感性、特异性、阳性预测值（PPV）和阴性预测值（NPV）。
冠状动脉节段图像质量评级为差的比例如下：四排CT为33.1%，第一代16排CT为14.4%，第二代16排CT为6.3%，64排CT为2.6%。敏感性、特异性、PPV和NPV分别如下：四排CT为57%、91%、60%和90%；第一代16排CT为90%、93%、65%和99%；第二代16排CT为97%、98%、87%和100%；64排CT为99%、96%、80%和100%。四排CT的诊断性能显著低于第二代16排CT（优势比=4.57）和64排CT（优势比=2.89）。
不同代的扫描仪冠状动脉CT血管造影的诊断性能有所不同。早期的扫描仪（四排）性能明显较差；与64排CT扫描仪相比，16排CT扫描仪的性能有逐步改善，尽管不显著。
