Casciani E, Polettini E, Bertini L, Rotolo F, Truscelli G, Pittalis A, Masselli G, Campagnano S, Pastore R, Gualdi G F
Radiologia DEA, Azienda Policlinico Umberto I, Università La Sapienza, Roma, Italia.
Clin Ter. 2008 Jan-Feb;159(1):5-12.
The diagnosis of acute coronary syndrome (ACS), non-ST-elevation myocardial infarction and unstable angina in the emergency department (ED) remains a challenge. The aim of our study was to investigate quality and the diagnostic accuracy of 16-MDCT coronary angiography, detecting coronary artery lesions in patients with suspected ACS presented in ED.
We studied with 16-MDCT (Sensation 16, Siemens, Forchleim, Germania) and coronary angiography 37 patients with the following inclusion criteria: chest pain compatible with myocardial ischemia, normal or no-diagnostic ECG changes and initial concentrations of serum troponin-I < or =1 ng/ml. The 16-MDCT was performed with ECG-gated technique after the intravenous administration of 90-100 ml of iodinated contrast material followed by a saline bolus. The scan parameters were: 120 kV, 650-720 mAs, 16 x 0.75mm collimation, 0.42s rotation time, 3 mm (pitch 0.25) feed/rot, B30f kernel. We evaluated for each patient: image quality and different artefacts, plaques identification and characterization.
The evaluation of the image quality was based on a total of 453 segments, of which 415 segments (92.2%) were considered to have diagnostic image quality. MDCT correctly detected 15 patients with at least 1 stenosis >50% and correctly ruled out significant coronary artery disease in 19 patients with 1 FP and 2 FN: sensitivity 88%, specificity 95%, PPV 94%, NPV 90%. The plaques were hard in 6 cases, mixt in 16 cases and soft in 14 cases, respectively.
Our results point-out that 16-MDCT in ED has the real ability to detect and rule out significant coronary stenoses in patients with ACS.
在急诊科对急性冠状动脉综合征（ACS）、非ST段抬高型心肌梗死和不稳定型心绞痛进行诊断仍然是一项挑战。我们研究的目的是调查16层螺旋CT冠状动脉造影的质量和诊断准确性，以检测急诊科疑似ACS患者的冠状动脉病变。
我们使用16层螺旋CT（Sensation 16，西门子，福尔希海姆，德国）和冠状动脉造影对37例患者进行了研究，这些患者符合以下纳入标准：胸痛与心肌缺血相符、心电图改变正常或无诊断意义，且血清肌钙蛋白I初始浓度≤1 ng/ml。在静脉注射90 - 100 ml碘化造影剂后，接着注射生理盐水团注，采用心电图门控技术进行16层螺旋CT扫描。扫描参数为：120 kV、650 - 720 mAs、16×0.75mm准直、0.42秒旋转时间、3 mm（螺距0.25）进床/旋转，B30f内核。我们对每位患者评估了：图像质量和不同伪影、斑块识别与特征。
基于总共453个节段对图像质量进行评估，其中415个节段（92.2%）被认为具有诊断性图像质量。16层螺旋CT正确检测出15例至少有一处狭窄>50%的患者，并正确排除了19例有1例假阳性和2例假阴性的患者的严重冠状动脉疾病：敏感性88%，特异性95%，阳性预测值94%，阴性预测值90%。斑块分别为硬斑块6例、混合斑块16例和软斑块14例。
我们的结果表明，急诊科的16层螺旋CT确实有能力检测和排除ACS患者的严重冠状动脉狭窄。
