64排螺旋CT冠状动脉造影的局限性：钙化、运动因素而非经验不足。

Limitations of 64-detector-row computed tomography coronary angiography: calcium and motion but not short experience.

作者信息

Mir-Akbari H, Ripsweden J, Jensen J, Pichler P, Sylvén C, Cederlund K, Rück A

机构信息

Division of Cardiology, Department of Internal Medicine, Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden.

出版信息

Acta Radiol. 2009 Mar;50(2):174-80. doi: 10.1080/02841850802647013.

DOI:10.1080/02841850802647013

PMID:19169918

Abstract

BACKGROUND

Recently, 64-detector-row computed tomography coronary angiography (CTA) has been introduced for the noninvasive diagnosis of coronary artery disease.

PURPOSE

To evaluate the diagnostic capacity and limitations of a newly established CTA service.

MATERIAL AND METHODS

In 101 outpatients with suspected coronary artery disease, 64-detector-row CTA (VCT Lightspeed 64; GE Healthcare, Milwaukee, Wisc., USA) was performed before invasive coronary angiography (ICA). The presence of >50% diameter coronary stenosis on CTA was rated by two radiologists recently trained in CTA, and separately by an experienced colleague. Diagnostic performance of CTA was calculated on segment, vessel, and patient levels, using ICA as a reference. Segments with a proximal reference diameter <2 mm or with stents were not analyzed.

RESULTS

In 51 of 101 patients and 121 of 1280 segments, ICA detected coronary stenosis. In 274 of 1280 (21%) segments, CTA had non-diagnostic image quality, the main reasons being severe calcifications (49%), motion artifacts associated with high or irregular heart rate (45%), and low contrast opacification (14%). Significantly more women (43%) had non-diagnostic scans compared to men (20%). A heart rate above 60 beats per minute was associated with significantly more non-diagnostic patients (38% vs. 18%). In the 1006 diagnostic segments, CTA had a sensitivity of 78%, specificity of 95%, positive predictive value (PPV) of 54%, and negative predictive value (NPV) of 98% for detecting significant coronary stenosis. In 29 patients, CTA was non-diagnostic. In the remaining 72 patients, sensitivity was 100%, specificity 65%, PPV 79%, and NPV 100%. The use of a more experienced CTA reader did not improve diagnostic performance.

CONCLUSION

CTA had a very high negative predictive value, but the number of non-diagnostic scans was high, especially in women. The main limitations were motion artifacts and vessel calcifications, while short experience in CTA did not influence the interpretation.

摘要

背景

最近，64排螺旋计算机断层扫描冠状动脉造影（CTA）已被用于冠状动脉疾病的无创诊断。

目的

评估一项新建立的CTA服务的诊断能力和局限性。

材料与方法

对101例疑似冠状动脉疾病的门诊患者，在进行有创冠状动脉造影（ICA）之前，先进行64排CTA（VCT Lightspeed 64；美国威斯康星州密尔沃基市通用电气医疗集团）检查。由两名最近接受CTA培训的放射科医生以及一名经验丰富的同事分别对CTA上直径狭窄>50%的冠状动脉进行评估。以ICA作为参考，在节段、血管和患者层面计算CTA的诊断性能。近端参考直径<2mm或有支架的节段不进行分析。

结果

101例患者中的51例以及1280个节段中的121个节段，ICA检测到冠状动脉狭窄。在1280个节段中的274个（21%）节段，CTA图像质量无法诊断，主要原因是严重钙化（49%）、与高心率或不规则心率相关的运动伪影（45%）以及低对比剂充盈（14%）。与男性（20%）相比，女性中无法诊断的扫描比例显著更高（43%）。心率高于每分钟60次与无法诊断的患者显著更多相关（38%对18%）。在1006个可诊断节段中，CTA检测显著冠状动脉狭窄的敏感性为78%，特异性为95%，阳性预测值（PPV）为54%，阴性预测值（NPV）为98%。29例患者的CTA无法诊断。在其余72例患者中，敏感性为100%，特异性为65%，PPV为79%，NPV为100%。使用经验更丰富的CTA阅片者并未提高诊断性能。