Nicol Edward D, Stirrup James, Reyes Eliana, Roughton Michael, Padley Simon P G, Rubens Michael B, Underwood S Richard
Department of Cardiology, Royal Brompton Hospital and Harefield National Health Service Trust, London, United Kingdom.
J Nucl Cardiol. 2008 May-Jun;15(3):311-8. doi: 10.1016/j.nuclcard.2008.02.017. Epub 2008 Apr 16.
Multislice computed tomography coronary angiography (CTA) was proposed as a method for investigating possible coronary artery disease (CAD) in patients who present with chest pain but with a low to intermediate likelihood of CAD. Sixty-four-channel CTA was compared prospectively with (99m)Tc-tetrofosmin myocardial perfusion scintigraphy (MPS) (as the gold standard in the detection of flow-limiting stenoses) for the detection of functionally significant CAD.
Fifty-two consecutive symptomatic patients with a low to intermediate likelihood of coronary artery disease, and who were referred for MPS, also underwent CTA. The CTA datasets were analyzed by two experienced observers who were blinded to the MPS data, and coronary artery segments were reported as < 50%, 50% to 69%, 70% to 99% stenoses, or occluded. The MPS images were similarly analyzed for inducible perfusion abnormalities, and coronary territories were identified. At the patient level, agreement between CTA and MPS for CTA lesions at >/= 50% was 87% (sensitivity, 100%; specificity, 84%; positive predictive value, 50%; negative predictive value, 100%). For CTA lesions, agreement at >/= 70% was 96% (sensitivity, 86%; specificity, 98%; positive predictive value, 86%; negative predictive value, 98%).
In patients with a low to intermediate likelihood of CAD, there is good correlation between MPS and CTA for the detection of functionally significant coronary artery stenoses when CTA detects a narrowing of >/= 70% severity. Computed tomography coronary angiography stenoses of 70% should be used to determine functional significance, and not 50%, as is the usual practice at present.
多层螺旋计算机断层扫描冠状动脉造影（CTA）被提议作为一种用于调查出现胸痛但患冠状动脉疾病（CAD）可能性较低至中等的患者是否可能患有CAD的方法。前瞻性地比较了64排CTA与（99m）锝-替曲膦心肌灌注闪烁显像（MPS）（作为检测血流限制性狭窄的金标准）用于检测具有功能意义的CAD。
52例连续的有症状且患CAD可能性较低至中等并被转诊进行MPS检查的患者也接受了CTA检查。由两名对MPS数据不知情的经验丰富的观察者分析CTA数据集，并将冠状动脉节段报告为狭窄<50%、50%至69%、70%至99%或闭塞。对MPS图像同样分析其诱导性灌注异常，并识别冠状动脉区域。在患者层面，CTA与MPS对于≥50%的CTA病变的一致性为87%（敏感性100%；特异性84%；阳性预测值50%；阴性预测值100%）。对于CTA病变，≥70%时的一致性为96%（敏感性86%；特异性98%；阳性预测值86%；阴性预测值98%）。
在患CAD可能性较低至中等的患者中，当CTA检测到严重程度≥70%的狭窄时，MPS与CTA在检测具有功能意义的冠状动脉狭窄方面具有良好的相关性。计算机断层扫描冠状动脉造影70%的狭窄应被用于确定功能意义，而不是目前通常采用的50%。
