Alessandri N, Di Matteo A, Rondoni G, Petrassi M, Tufani F, Ferrari R, Laghi A
Dipartimento del Cuore e Grossi Vasi A. Reale, University of Rome La Sapienza, Polo Pontino, Rome, Italy.
Eur Rev Med Pharmacol Sci. 2009 May-Jun;13(3):163-71.
At present, coronary angiography represents the gold standard technique for the diagnosis of coronary artery disease. Our aim is to compare the conventional coronary angiography to the coronary 64-multislice spiral computed tomography (64-MSCT), a new and non-invasive cardiac imaging technique. The last generation of MSCT scanners show a better imaging quality, due to a greater spatial and temporal resolution. Four expert observers (two cardiologists and two radiologists) have compared the angiographic data with the accuracy of the 64-MSCT in the detection and evaluation of coronary vessels stenoses. From the data obtained, the sensibility, the specificity and the accuracy of the coronary 64-MSCT have been defined. We have enrolled 75 patients (57 male, 18 female, mean age 61.83 +/- 10.38; range 30-80 years) with known or suspected coronary artery disease. The above population has been divided into 3 groups: Group A (Gr. A) with 40 patients (mean age 60.7 +/- 12.5) affected by both non-significant and significant coronary artery disease; Group B (Gr. B) with 25 patients (mean age 60.3 +/- 14.6) who underwent to percutaneous coronary intervention (PCI); Group C (Gr. C) with 10 patients (mean age 54.20 +/- 13.7) without any coronary angiographic stenoses. All the patients underwent non-invasive exams, conventional coronary angiography and coronary 64-MSCT. The comparison of the data obtained has been carried out according to a per group analysis, per patient analysis and per segment analysis. Moreover, the accuracy of the 64-MSCT has been defined for the detection of >75%, 50-75% and <50% coronary stenoses. Coronary angiography has identified significant coronary artery disease in 75% of the patients in the Gr. A and in 73% of the patients in the Gr. B. No coronary stenoses have been detected in Gr. C. According to a per segment analysis, in Gr. A, 36% of the segments analysed have shown a coronary stenosis (37% stenoses >75%, 32% stenoses 50-75% and 31% stenoses <50%). In Gr. B, 32% of the segments have shown a coronary stenosis (33% stenoses >75%, 29% stenoses 50-75% and 38% stenoses <50%). In-stent disease has been shown in only 4 of the 29 coronary stents identified. In Gr. A, coronary 64-MSCT has confirmed the angiographic results in the 93% of cases (sensibility 93%, specificity 100%, positive predictive value 100% and negative predictive value 83%) while, in Gr. B, this confirm has been obtained only in 64% of cases (sensibility 64%, specificity 100%, positive predictive value 100% and negative predictive value 50%). In Gr. C, we have observed a complete agreement between angiographic and CT data (sensibility, specificity, positive predictive value and negative predictive value 100%). According to a per segment analysis, the angiographic results have been confirmed in 98% of cases in Gr. A (sensibility 98%, specificity 94%, positive predictive value 90% and negative predictive value 94%) but only in 55% of cases in Gr. B (sensibility 55%, specificity 90%, positive predictive value 71% and negative predictive value 81%). Moreover, only 1 of the 4 in-stent restenoses has been detected (sensibility 25%, specificity 100%, positive predictive value 100% and negative predictive value 77%). Coronary angiography has detected a greater number of coronary stenoses than the 64-MSCT. 64-MSCT has demonstrated better accuracy in the study of coronary vessels wider than 2 mm, while its accuracy is lower for smaller vessels (diameter < 2.5 mm) and for the identification of in-stent restenosis, because there is a reduced image quality for these vessels and therefore a lower accuracy in the coronary stenosis detection. Nevertheless, 64-MSCT shows high accuracy and it can be considered a comparative but not a substitutive exam of the coronary angiography. Several technical limitations of the 64-MSCT are responsible of its lower accuracy versus the conventional coronary angiography, but solving these technical problems could give us a new non-invasive imaging technique for the study of coronary stents.
目前，冠状动脉造影是诊断冠状动脉疾病的金标准技术。我们的目的是将传统冠状动脉造影与冠状动脉64层螺旋计算机断层扫描（64-MSCT）进行比较，后者是一种新的无创心脏成像技术。最新一代的MSCT扫描仪由于具有更高的空间和时间分辨率，显示出更好的成像质量。四位专家观察者（两位心脏病专家和两位放射科医生）将血管造影数据与64-MSCT在检测和评估冠状动脉狭窄方面的准确性进行了比较。根据获得的数据，确定了冠状动脉64-MSCT的敏感性、特异性和准确性。我们纳入了75例已知或疑似冠状动脉疾病的患者（57例男性，18例女性，平均年龄61.83±10.38岁；年龄范围30-80岁）。上述人群被分为3组：A组（Gr. A）有40例患者（平均年龄60.7±12.5岁），患有非显著性和显著性冠状动脉疾病；B组（Gr. B）有25例患者（平均年龄60.3±14.6岁），接受了经皮冠状动脉介入治疗（PCI）；C组（Gr. C）有10例患者（平均年龄54.20±13.7岁），无任何冠状动脉造影狭窄。所有患者均接受了无创检查、传统冠状动脉造影和冠状动脉64-MSCT检查。根据每组分析、每位患者分析和每段分析对获得的数据进行了比较。此外，还确定了64-MSCT在检测>75%、50-75%和<50%冠状动脉狭窄方面的准确性。冠状动脉造影在A组75%的患者和B组73%的患者中发现了显著性冠状动脉疾病。C组未检测到冠状动脉狭窄。根据每段分析，在A组中，36%的分析段显示有冠状动脉狭窄（37%的狭窄>75%，32%的狭窄为50-75%，31%的狭窄<50%）。在B组中，32%的段显示有冠状动脉狭窄（33%的狭窄>75%，29%的狭窄为50-75%，38%的狭窄<50%）。在29个已识别的冠状动脉支架中，仅4个显示有支架内疾病。在A组中，冠状动脉64-MSCT在93%的病例中证实了血管造影结果（敏感性93%，特异性100%，阳性预测值100%，阴性预测值83%），而在B组中，仅在64%的病例中获得了这种证实（敏感性64%，特异性100%，阳性预测值100%，阴性预测值50%）。在C组中，我们观察到血管造影和CT数据完全一致（敏感性、特异性、阳性预测值和阴性预测值均为100%）。根据每段分析，A组中98%的病例证实了血管造影结果（敏感性98%，特异性94%，阳性预测值90%，阴性预测值94%），但B组中仅55%的病例得到证实（敏感性55%，特异性90%，阳性预测值71%，阴性预测值81%）。此外，4个支架内再狭窄中仅检测到1个（敏感性25%，特异性100%，阳性预测值100%，阴性预测值77%）。冠状动脉造影检测到的冠状动脉狭窄数量比64-MSCT多。64-MSCT在研究直径大于2mm的冠状动脉时显示出更好的准确性，而对于较小的血管（直径<2.5mm）和支架内再狭窄的识别，其准确性较低，因为这些血管的图像质量下降，因此在冠状动脉狭窄检测中的准确性较低。然而，64-MSCT显示出较高的准确性，可被视为冠状动脉造影的一种对比性而非替代性检查。64-MSCT的一些技术局限性导致其相对于传统冠状动脉造影的准确性较低，但解决这些技术问题可能会为我们提供一种用于研究冠状动脉支架的新的无创成像技术。
