冠状动脉疾病的有创评估与无创评估

Invasive versus noninvasive evaluation of coronary artery disease.

作者信息

Schuijf Joanne D, van Werkhoven Jacob M, Pundziute Gabija, Jukema J Wouter, Decramer Isabel, Stokkel Marcel P, Dibbets-Schneider Petra, Schalij Martin J, Reiber Johannes H C, van der Wall Ernst E, Wijns William, Bax Jeroen J

机构信息

Department of Cardiology, Leiden University Medical Center, the Netherlands.

出版信息

JACC Cardiovasc Imaging. 2008 Mar;1(2):190-9. doi: 10.1016/j.jcmg.2007.12.003.

DOI:10.1016/j.jcmg.2007.12.003

PMID:19356428

Abstract

OBJECTIVES

We sought to compare the diagnostic information obtained from noninvasive characterization of coronary artery disease by using multidetector computed tomography (MDCT) and myocardial perfusion imaging (MPI) and to compare findings with the use of invasive coronary angiography and intravascular ultrasound (IVUS).

BACKGROUND

Preliminary comparisons have suggested that abnormal myocardial perfusion studies correlate well with significant luminal stenosis on MDCT coronary angiography. However, atherosclerotic coronary lesions may be detectable with the use of MDCT even in the presence of normal myocardial perfusion

METHODS

We performed MDCT, MPI, and conventional coronary angiography in 70 patients. In addition, IVUS was performed in 53 patients. Quantitative information was obtained from quantitative coronary angiography (QCA) and IVUS assessment of plaque burden and minimal luminal area.

RESULTS

Of 26 patients with an abnormal MPI study, 23 (88%) showed significant stenosis on MDCT. As compared with QCA, MDCT showed a sensitivity of 96% and specificity of 67% for the detection of stenoses > or =50% diameter narrowing in these patients. Mean diameter stenosis on QCA was 76% and mean minimal lumen area in IVUS was 3.3 mm(2). On the other hand, 27 (84%) of 44 patients with normal MPI had evidence of coronary atherosclerosis on MDCT (luminal stenosis > or =50%: n = 15, luminal stenosis <50%: n = 12, sensitivity of 100% and specificity of 83% as compared with QCA). Using IVUS, we found substantial plaque burden (mean 58.9 +/- 18.1% of cross-sectional area), but presence of a stenosis (minimal lumen area <4.0 mm(2)) in only 14 patients (mean minimal lumen area, 5.8 +/- 3.3 mm(2)). Only 7 patients with normal myocardial perfusion scans demonstrated absence of coronary atherosclerosis by MDCT.

CONCLUSIONS

Considerable plaque burden can be observed with MDCT even in the absence of myocardial perfusion abnormalities. This finding does not constitute a false-positive MDCT result, but rather reflects the fact that MDCT can detect atherosclerotic lesions that are not flow-limiting.

摘要

目的

我们试图比较使用多排螺旋计算机断层扫描（MDCT）和心肌灌注成像（MPI）对冠状动脉疾病进行无创特征分析所获得的诊断信息，并将结果与有创冠状动脉造影和血管内超声（IVUS）的结果进行比较。

背景

初步比较表明，心肌灌注异常研究与MDCT冠状动脉造影上的显著管腔狭窄密切相关。然而，即使心肌灌注正常，使用MDCT也可能检测到动脉粥样硬化性冠状动脉病变。

方法

我们对70例患者进行了MDCT、MPI和传统冠状动脉造影。此外，对53例患者进行了IVUS检查。从定量冠状动脉造影（QCA）和IVUS对斑块负荷和最小管腔面积的评估中获得定量信息。

结果

在26例MPI研究异常的患者中，23例（88%）在MDCT上显示有显著狭窄。与QCA相比，MDCT对这些患者中直径狭窄≥50%的狭窄检测的敏感性为96%，特异性为67%。QCA上的平均直径狭窄为76%，IVUS上的平均最小管腔面积为3.3 mm²。另一方面，44例MPI正常的患者中有27例（84%）在MDCT上有冠状动脉粥样硬化证据（管腔狭窄≥50%：15例，管腔狭窄<50%：12例，与QCA相比敏感性为100%，特异性为83%）。使用IVUS，我们发现有大量斑块负荷（平均占横截面积的58.9±18.1%），但只有14例患者存在狭窄（最小管腔面积<4.0 mm²）（平均最小管腔面积，5.8±3.3 mm²）。只有7例心肌灌注扫描正常的患者通过MDCT显示无冠状动脉粥样硬化。