Joshi Subodh B, Okabe Teruo, Roswell Robert O, Weissman Gaby, Lopez Cristian F, Lindsay Joseph, Pichard Augusto D, Weissman Neil J, Waksman Ron, Weigold Wm Guy
Department of Cardiology, Washington Hospital Center, Washington, DC, USA.
Am J Cardiol. 2009 Oct 15;104(8):1047-51. doi: 10.1016/j.amjcard.2009.05.052.
Computed tomographic angiography (CTA) is considered to have limited accuracy for quantifying exact percent diameter stenosis in coronary arteries. However, most studies evaluating CTA use quantitative coronary angiography (QCA) as the gold standard, a technique with its own limitations. We sought to determine whether CTA measurements of stenosis severity correlate better with intravascular ultrasound (IVUS) than with QCA. Luminal dimensions of 67 de novo coronary lesions were measured by CTA, IVUS, and QCA. IVUS was performed when lesion severity by angiography was equivocal. Mean percent diameter stenosis by QCA was 51 +/- 9.8% and mean IVUS minimal luminal area was 3.8 +/- 1.8 mm(2). There was a moderate correlation between CTA minimal luminal area and IVUS minimal luminal area (r(2) = 0.41, p <0.001), but no relation between CTA and QCA measurements of minimal luminal diameter (r(2) = 0.01, p = 0.57) or diameter stenosis (r(2) = 0.02, p = 0.31). There was also no relation between IVUS minimal luminal area and QCA diameter stenosis (r(2) = 0.01, p = 0.50). When lesions with moderate or severe calcification were excluded, the correlation between CTA minimal luminal area and IVUS minimal luminal area was good (r(2) = 0.68, p <0.001). In conclusion, in this cohort of patients with intermediate-grade lesions on cardiac catheterization, absolute measurements of stenosis severity on CTA correlated with IVUS but not with QCA. Our findings suggest that limitations of quantitative coronary angiography as a gold standard need to be considered in studies evaluating the accuracy of coronary CTA.
计算机断层血管造影（CTA）在定量冠状动脉确切的直径狭窄百分比方面被认为准确性有限。然而，大多数评估CTA的研究将定量冠状动脉造影（QCA）用作金标准，而该技术本身也存在局限性。我们试图确定CTA测量的狭窄严重程度与血管内超声（IVUS）的相关性是否优于与QCA的相关性。通过CTA、IVUS和QCA测量了67处新发冠状动脉病变的管腔尺寸。当血管造影显示的病变严重程度不明确时，进行IVUS检查。QCA测得的平均直径狭窄百分比为51±9.8%，IVUS测得的平均最小管腔面积为3.8±1.8mm²。CTA最小管腔面积与IVUS最小管腔面积之间存在中度相关性（r² = 0.41，p <0.001），但CTA与QCA测量的最小管腔直径（r² = 0.01，p = 0.57）或直径狭窄（r² = 0.02，p = 0.31）之间无相关性。IVUS最小管腔面积与QCA直径狭窄之间也无相关性（r² = 0.01，p = 0.50）。排除中度或重度钙化病变后，CTA最小管腔面积与IVUS最小管腔面积之间的相关性良好（r² = 0.68，p <0.001）。总之，在这组心脏导管检查显示为中度病变的患者中，CTA上狭窄严重程度的绝对测量值与IVUS相关，但与QCA不相关。我们的研究结果表明，在评估冠状动脉CTA准确性的研究中，需要考虑将定量冠状动脉造影作为金标准的局限性。
