Garcia M J
Department of Cardiovascular Imaging, Cardiovascular Institute, Mount Sinai Medical School, New York, NY 10029, USA.
J Cardiovasc Surg (Torino). 2009 Feb;50(1):7-17.
Recent technological advances have led to a substantial increase in image quality in multi-detector computed tomography (MDCT). Over the last few years, there has been significant interest and controversy about the clinical application of CT angiography for the evaluation of the coronary anatomy in patients with suspected coronary artery disease (CAD). Unlike invasive coronary angiography, CT coronary angiography provides both visualization of the lumen and the coronary vessel wall. Calcified plaques can be detected without contrast administration and easily quantified. MDCT has largely replaced electron beam computerized tomography for calcium scoring. Growing evidence suggests that measurement of coronary calcium may be particularly valuable in therapy decisions for asymptomatic patients with an intermediate risk of coronary events. Recent studies have also shown an association between non-calcified coronary plaques and acute coronary syndromes in patients with stable angina. Contrast-enhanced CT coronary angiography provides a non-invasive alternative to intravascular ultrasound to evaluate coronary plaque morphology and severity. Contrast-enhanced CT has been extensively validated for the detection of coronary artery stenosis in symptomatic patients with known or suspected CAD. The number of non-evaluable cases has been reduced below 10% with the newest generation scanners. Although there is considerable enthusiasm, many doubts remain about the appropriate clinical indications of CT coronary angiography, even though most experts believe that the high negative predictive value of CT coronary angiography makes this test ideal for establishing or excluding coronary artery disease in patients with low-intermediate probability.
近年来的技术进步使得多排螺旋计算机断层扫描（MDCT）的图像质量有了显著提高。在过去几年中，对于CT血管造影在疑似冠状动脉疾病（CAD）患者冠状动脉解剖结构评估中的临床应用，人们有着浓厚的兴趣且存在争议。与有创冠状动脉造影不同，CT冠状动脉造影既能显示管腔，又能显示冠状动脉血管壁。无需注射造影剂就能检测出钙化斑块，并且易于量化。MDCT在很大程度上已取代电子束计算机断层扫描用于钙化积分。越来越多的证据表明，对于有冠状动脉事件中度风险的无症状患者，冠状动脉钙化测量在治疗决策中可能特别有价值。最近的研究还表明，稳定型心绞痛患者的非钙化冠状动脉斑块与急性冠状动脉综合征之间存在关联。对比增强CT冠状动脉造影为评估冠状动脉斑块形态和严重程度提供了一种非侵入性替代血管内超声的方法。对比增强CT已在有已知或疑似CAD的有症状患者中广泛验证用于检测冠状动脉狭窄。使用最新一代扫描仪，不可评估病例的数量已降至10%以下。尽管人们热情高涨，但对于CT冠状动脉造影的适当临床适应症仍存在许多疑问，尽管大多数专家认为CT冠状动脉造影的高阴性预测价值使其成为在中低概率患者中确立或排除冠状动脉疾病的理想检查。
