超越冠状动脉计算机断层血管造影术对冠状动脉狭窄的二元分级：对影像科医生和转诊临床医生的启示
Moving beyond binary grading of coronary arterial stenoses on coronary computed tomographic angiography: insights for the imager and referring clinician.
作者信息
Cheng Victor, Gutstein Ariel, Wolak Arik, Suzuki Yasuyuki, Dey Damini, Gransar Heidi, Thomson Louise E J, Hayes Sean W, Friedman John D, Berman Daniel S
机构信息
Department of Internal Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA.
出版信息
JACC Cardiovasc Imaging. 2008 Jul;1(4):460-71. doi: 10.1016/j.jcmg.2008.05.006.
OBJECTIVES
We evaluated the technical and clinical utility of visual 5-point coronary stenosis grading on coronary computed tomographic angiography (CCTA).
BACKGROUND
The binary approach used to assess coronary stenoses on CCTA does not adequately describe borderline obstructive lesions and limits full expression of clinically useful information.
METHODS
From 84 patients who underwent CCTA and invasive angiography, we identified 278 native coronary segments with > or =25% stenosis on CCTA after excluding all <25% stenotic, stented, and uninterpretable segments. Fifty <25% stenotic segments were randomly selected as controls. Segmental stenosis severity on CCTA was consensually graded using a 0 to 5 scale (grade 0 = none, grade 1 = 1% to 24%, grade 2 = 25% to 49%, grade 3 = 50% to 69%, grade 4 = 70% to 89%, grade 5 = 90% to 100%) by 2 readers, using visual inspection and computed tomography-based quantification (CTQCA). Invasive angiography-based stenosis quantification (IQCA) was performed for all segments, using the same 0 to 5 scale to score stenosis severity.
RESULTS
On CCTA, 185 (56%) segments had intermediate stenoses (grade 2 or grade 3). Stenosis severity by IQCA increased significantly with each step-up in CCTA grade (p < 0.001). CTQCA did not perform better than visual inspection. Visual CCTA stenosis grading differed from IQCA by >1 grade in only 4% of grade 2 to grade 5 segments (10 of 278; 2% of CCTA grade 2 segments, 4% of grade 3, 8% of grade 4, 2% of grade 5). Overall quantitative correlation was strong (r = 0.82) with high variability in agreement between CTQCA and IQCA for individual segments (95% of differences between 27.2% and 34.6%).
CONCLUSIONS
With current CCTA technology, experienced readers should consider adopting a visually based, multitiered grading approach to evaluate coronary stenoses. A < or =49% lesion on CCTA can be considered virtually exclusive of > or =70% stenosis by invasive angiography.
目的
我们评估了冠状动脉计算机断层血管造影（CCTA）上视觉5分冠状动脉狭窄分级的技术和临床实用性。
背景
用于评估CCTA上冠状动脉狭窄的二元方法不能充分描述临界性阻塞性病变，限制了临床有用信息的充分表达。
方法
在84例行CCTA和有创血管造影的患者中，排除所有狭窄程度<25%、置入支架和无法解读的节段后，我们确定了278个CCTA上狭窄程度≥25%的天然冠状动脉节段。随机选择50个狭窄程度<25%的节段作为对照。由2名阅片者通过视觉检查和基于计算机断层扫描的定量分析（CTQCA），采用0至5分制（0级=无狭窄，1级=1%至24%，2级=25%至49%，3级=50%至69%，4级=70%至89%，5级=90%至100%）对CCTA上的节段狭窄严重程度进行共识分级。对所有节段进行基于有创血管造影的狭窄定量分析（IQCA），采用相同的0至5分制对狭窄严重程度进行评分。
结果
在CCTA上，185个（56%）节段存在中度狭窄（2级或3级）。IQCA显示的狭窄严重程度随CCTA分级的每一步升高而显著增加（p<0.001）。CTQCA的表现并不优于视觉检查。在2级至5级节段中，视觉CCTA狭窄分级与IQCA相差>1级的仅占4%（278个中的10个；CCTA 2级节段的2%，3级的4%，4级的8%，5级的2%）。总体定量相关性较强（r=0.82），CTQCA和IQCA对单个节段的一致性差异较大（95%的差异在27.2%至34.6%之间）。
结论
对于当前的CCTA技术，有经验的阅片者应考虑采用基于视觉的多层分级方法来评估冠状动脉狭窄。CCTA上≤49%的病变在有创血管造影中几乎不可能存在≥70%的狭窄。
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