Pouleur Anne-Catherine, le Polain de Waroux Jean-Benoît, Kefer Joelle, Pasquet Agnès, Vanoverschelde Jean-Louis, Gerber Bernhard L
Divisions of Cardiology, Cliniques Universitaires St. Luc UCL, Brussels, Belgium.
Circ Cardiovasc Imaging. 2008 Sep;1(2):114-21. doi: 10.1161/CIRCIMAGING.107.756304. Epub 2008 Jul 30.
Both whole-heart magnetic resonance coronary angiography (WH-MRCA) and multidetector computed tomography (MDCT) have been proposed for the noninvasive identification of the coronary stenosis. The authors sought to directly compare the diagnostic accuracy of these noninvasive imaging techniques using the invasive quantitative coronary angiography as a reference standard.
Seventy-seven consecutive patients (56 men, 61+/-14 years) prospectively underwent WH-MRCA and 40- or 64-slice MDCT before the quantitative coronary angiography. Diagnostic accuracy of WH-MRCA and MDCT for the visual identification of >50% diameter stenosis in segments of >1.5 mm size was compared using the quantitative coronary angiography as a reference. According to the quantitative coronary angiography, 49 of 992 coronary segments >1.5 mm diameter had >50% diameter stenosis. MDCT had a higher success rate (100% versus 88%, P<0.001) and enabled identification of more segments (963 versus 726, P<0.001) than did WH-MRCA. On a per-segment basis, WH-MRCA had similar sensitivity (47/49 or 96% versus 48/49 or 98%, P=0.9) but significantly lower specificity (644/943 or 68% versus 863/943 or 92%, P<0.001) and accuracy (691/992 or 70% versus 911/992 or 92%, P<0.001) for the detection of >50% diameter stenosis than did MDCT. On a per-patient basis, the sensitivity was similar (17/17 or 100% versus 16/17 or 94%, P=0.9), but specificity (43/60 or 72% versus 53/60 or 88%, P=0.024) and diagnostic accuracy (60/77 or 78%, versus 69/77 or 90%, P=0.044) of WH-MRCA for the detection of >50% diameter stenosis were significantly lower than of MDCT.
Because of the higher success rate and higher number of interpretable segments, 40- or 64-slice MDCT performs better than WH-MRCA.
全心脏磁共振冠状动脉造影（WH-MRCA）和多排螺旋计算机断层扫描（MDCT）均已被用于冠状动脉狭窄的无创性识别。作者试图以有创性定量冠状动脉造影作为参考标准，直接比较这些无创成像技术的诊断准确性。
77例连续患者（56例男性，年龄61±14岁）在进行定量冠状动脉造影前，前瞻性地接受了WH-MRCA和40层或64层MDCT检查。以定量冠状动脉造影作为参考，比较WH-MRCA和MDCT对直径>1.5 mm节段中直径狭窄>50%的视觉识别诊断准确性。根据定量冠状动脉造影，992个直径>1.5 mm的冠状动脉节段中，49个存在直径狭窄>50%。与WH-MRCA相比，MDCT的成功率更高（100%对88%，P<0.001），能够识别更多节段（963个对726个，P<0.001）。在每个节段基础上，对于检测直径狭窄>50%，WH-MRCA的敏感性相似（47/49或96%对48/49或98%，P=0.9），但特异性（644/943或68%对863/943或92%，P<0.001）和准确性（691/992或70%对911/992或92%，P<0.001）显著低于MDCT。在每位患者基础上，敏感性相似（17/17或100%对16/17或94%，P=0.9），但WH-MRCA检测直径狭窄>50%的特异性（43/60或72%对53/60或88%，P=0.024）和诊断准确性（60/77或78%对69/77或90%，P=0.044）显著低于MDCT。
由于成功率更高且可解释节段数量更多，40层或64层MDCT的表现优于WH-MRCA。
