Institute of Diagnostic Radiology, University Hospital Zurich, Raemistrasse 100, 8091 Zurich, Switzerland.
Eur Radiol. 2010 Jan;20(1):56-64. doi: 10.1007/s00330-009-1536-x. Epub 2009 Aug 6.
The purpose of this study was to prospectively determine the accuracy of low-dose computed tomography coronary angiography (CTCA) for the diagnosis of functionally relevant coronary artery disease (CAD) using cardiac magnetic resonance (CMR) as a standard of reference. Forty-one consecutive patients (age 64 +/- 10 years) underwent k-space and time broad-use linear acquisition speed-up technique accelerated CMR (1.5 T) and dual-source CTCA using prospective electrocardiography gating within 1 day. CTCA lesions were analysed and diameter stenoses of more than 50% and more than 75% were compared with CMR findings taken as the reference standard for assessing the functional relevance of CAD. CMR revealed perfusion defects in 21/41 patients (51%). A total of 569 coronary segments were analysed with low-dose CTCA. The image quality of low-dose CTCA was diagnostic in 566/569 segments (99.5%) in 39/41 patients (95%). Low-dose CTCA revealed stenoses of more than 50% in 58/123 coronary arteries (47.2%) in 24/41 patients (59%) and more than 75% stenoses in 46/123 coronary arteries (37.4%) in 23/41 patients (56%). Using a greater than 50% diameter stenosis, low-dose CTCA yielded the following per artery sensitivity, specificity, positive and negative predictive values, and accuracy for the detection of perfusion defects: 89%, 79%, 72%, 92% and 83%, respectively. Low-dose CTCA is reliable for ruling out functionally relevant CAD, but is a poor predictor of myocardial ischaemia.
本研究旨在前瞻性地确定低剂量计算机断层冠状动脉成像（CTCA）诊断功能相关冠状动脉疾病（CAD）的准确性，以心脏磁共振（CMR）为参考标准。41 例连续患者（年龄 64 +/- 10 岁）在 1 天内接受了 k 空间和时间广泛使用的线性加速采集速度加速 CMR（1.5 T）和双源 CTCA，使用前瞻性心电图门控。对 CTCA 病变进行分析，并将狭窄程度大于 50%和大于 75%的病变与 CMR 结果进行比较，后者作为评估 CAD 功能相关性的参考标准。CMR 在 21/41 例患者（51%）中显示灌注缺损。用低剂量 CTCA 分析了 569 个冠状动脉节段。在 39/41 例患者（95%）的 566/569 个节段（99.5%）中，低剂量 CTCA 的图像质量具有诊断意义。低剂量 CTCA 在 24/41 例患者（59%）的 123 个冠状动脉中有 58 个（47.2%）显示狭窄程度大于 50%，在 23/41 例患者（56%）的 123 个冠状动脉中有 46 个（37.4%）显示狭窄程度大于 75%。使用大于 50%的直径狭窄程度，低剂量 CTCA 对检测灌注缺损的下列每支动脉的敏感性、特异性、阳性和阴性预测值和准确性分别为：89%、79%、72%、92%和 83%。低剂量 CTCA 可可靠地排除功能相关的 CAD，但对心肌缺血的预测能力较差。
