Carrascosa Patricia, Capuñay Carlos, Bettinotti Marcelo, Goldsmit Alejandro, Deviggiano Alejandro, Carrascosa Jorge, García Mario J
Department of Radiology, Diagnóstico Maipú, Buenos Aires, Argentina.
J Cardiovasc Comput Tomogr. 2007 Oct;1(2):86-94. doi: 10.1016/j.jcct.2007.06.003. Epub 2007 Jul 4.
Multidetector computed tomography (MDCT) has been proposed as a noninvasive method for the diagnosis of obstructive coronary artery disease (CAD). In patients with high risk of iodinated contrast adverse effects such as acute allergic-type reactions, the use of gadolinium could be an alternative.
We sought to evaluate the feasibility of gadolinium-enhanced MDCT for the diagnosis of obstructive CAD.
Twenty patients (mean age, 61 years; range, 50-73 years) referred for X-ray coronary angiography were studied by both gadolinium and iodine-enhanced 16-row MDCT coronary angiography. The degree of enhancement and the accuracy for detection of obstructive CAD (>50% diameter reduction) were evaluated with X-ray coronary angiography as the standard. Renal nephrotoxicity was strictly monitored.
Gadolinium- and iodine-enhanced MDCT showed adequate visualization of the coronary arteries in 310 of the 312 coronary artery segments that were available by X-ray angiography, respectively. The average density of the coronary arteries in both iodine and gadolinium CT scans was 253.65 Hounsfield unit (HU) and 135.20 HU, respectively. In a per-coronary segment analysis, gadolinium- and iodine-enhanced MDCT showed sensitivities of 89% vs 84%, specificities of 96% vs 95%, and negative predictive values of 97% vs 96%, respectively. In a per-patient analysis, both gadolinium- and iodine-enhanced MDCT showed sensitivities of 92.85% vs specificities of 83.33%. Intermethod agreement between gadolinium- and iodine-enhanced MDCT (kappa) was 0.95 (P < 0.0001).
Our preliminary results indicate lower attenuation with gadolinium but similar diagnostic accuracy for the detection of obstructive CAD when compared with iodine-enhanced MDCT. Therefore, gadolinium is a feasible alternative contrast agent for patients with iodine contrast allergy referred for MDCT coronary angiography.
多排螺旋计算机断层扫描（MDCT）已被提议作为诊断阻塞性冠状动脉疾病（CAD）的一种非侵入性方法。对于有碘造影剂不良反应高风险的患者，如急性过敏样反应，使用钆可能是一种替代方法。
我们试图评估钆增强MDCT诊断阻塞性CAD的可行性。
对20例（平均年龄61岁；范围50 - 73岁）因X线冠状动脉造影而就诊的患者进行了钆增强和碘增强16排MDCT冠状动脉造影研究。以X线冠状动脉造影为标准，评估增强程度和检测阻塞性CAD（直径减少>50%）的准确性。严格监测肾毒性。
钆增强和碘增强MDCT分别在X线血管造影可显示的312个冠状动脉节段中的310个节段中显示出冠状动脉的充分显影。碘和钆CT扫描中冠状动脉的平均密度分别为253.65亨氏单位（HU）和135.20 HU。在每个冠状动脉节段分析中，钆增强和碘增强MDCT的敏感性分别为89%对84%，特异性分别为96%对95%，阴性预测值分别为97%对96%。在每位患者分析中，钆增强和碘增强MDCT的敏感性分别为92.85%对特异性为83.33%。钆增强和碘增强MDCT之间的方法间一致性（kappa）为0.95（P < 0.0001）。
我们的初步结果表明，与碘增强MDCT相比，钆增强时衰减较低，但在检测阻塞性CAD方面诊断准确性相似。因此，对于因MDCT冠状动脉造影而有碘造影剂过敏的患者，钆是一种可行的替代造影剂。
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