Huber Steffen, Huber Martin, Dees Debra, Redmond Frank A, Wilson James M, Flamm Scott D
Department of Radiology, the Texas Heart Institute, St Luke's Episcopal Hospital, Houston, TX, USA.
J Cardiovasc Comput Tomogr. 2007 Jul;1(1):29-37. doi: 10.1016/j.jcct.2007.04.013. Epub 2007 May 18.
Despite reports that multislice spiral computed tomography (MSCT) has high sensitivity and specificity in preselected patient populations, the routine clinical feasibility and utility of MSCT coronary angiography in patients with acute chest pain in the emergency department remains uncertain.
We sought to determine whether 16-slice MSCT coronary angiography can provide diagnostically useful images in patients with acute chest pain in the emergency department.
Ninety-eight patients in the emergency department (41 men, 57 women; mean age +/- SD, 48.1 +/- 11.9 y) with acute chest pain underwent MSCT coronary angiography. Coronary calcium (Agatston) scoring was performed, followed by contrast-enhanced MSCT. Images were evaluated for mean image quality (MIQ) and for degree of stenosis. These data were correlated with body mass index (BMI; in kg/m(2)), heart rate, beat-to-beat variation, and calcium score to assess their influence on image quality.
The 28 patients (29%) with nondiagnostic MIQs had significantly higher BMIs (mean +/- SD, 32.9 +/- 9.1 vs 28.9 +/- 6.7; P < 0.05) and heart rates (mean +/- SD, 71.0 +/- 11.9 beats/min vs 65.6 +/- 9.9 beats/min; P < 0.05) than patients with diagnostic MIQs. Forty-five patients (46%) had at least 1 nondiagnostic coronary segment. These patients had significantly higher heart rates (mean +/- SD, 70.5 +/- 10.3 vs 64.1 +/- 13.7; P < 0.05) than patients with only diagnostic-quality scans. Image quality correlated inversely and strongly with BMI and heart rate.
Sixteen-slice MSCT coronary angiography cannot routinely provide diagnostically useful images in patients with acute chest pain in the emergency department.
尽管有报道称多层螺旋计算机断层扫描（MSCT）在预先选定的患者群体中具有较高的敏感性和特异性，但在急诊科急性胸痛患者中，MSCT冠状动脉造影的常规临床可行性和实用性仍不确定。
我们试图确定16层MSCT冠状动脉造影能否为急诊科急性胸痛患者提供具有诊断价值的图像。
98例急诊科急性胸痛患者（41例男性，57例女性；平均年龄±标准差，48.1±11.9岁）接受了MSCT冠状动脉造影。进行冠状动脉钙化（阿加斯顿）评分，随后进行对比增强MSCT。评估图像的平均图像质量（MIQ）和狭窄程度。这些数据与体重指数（BMI；单位为kg/m²）、心率、逐搏变化和钙化评分相关，以评估它们对图像质量的影响。
28例（29%）MIQ无法诊断的患者的BMI（平均±标准差，32.9±9.1 vs 28.9±6.7；P<0.05）和心率（平均±标准差，71.0±11.9次/分钟 vs 65.6±9.9次/分钟；P<0.05）显著高于MIQ可诊断的患者。45例（46%）患者至少有1个冠状动脉节段无法诊断。这些患者的心率（平均±标准差，70.5±10.3 vs 64.1±13.7；P<0.05）显著高于仅扫描质量可诊断的患者。图像质量与BMI和心率呈强烈负相关。
16层MSCT冠状动脉造影不能常规为急诊科急性胸痛患者提供具有诊断价值的图像。
