Andreini Daniele, Pontone Gianluca, Bartorelli Antonio L, Agostoni Piergiuseppe, Mushtaq Saima, Bertella Erika, Trabattoni Daniela, Cattadori Gaia, Cortinovis Sarah, Annoni Andrea, Castelli Alice, Ballerini Giovanni, Pepi Mauro
Centro Cardiologico Monzino, IRCCS, Institute of Cardiology, University of Milan, Italy.
Circ Cardiovasc Imaging. 2009 May;2(3):199-205. doi: 10.1161/CIRCIMAGING.108.822809. Epub 2009 Mar 24.
The goal of this study was to assess the safety, feasibility, and diagnostic accuracy of 64-slice multidetector computed tomography (MDCT) for the evaluation of coronary arteries in dilated cardiomyopathy (DCM) of unknown etiology. Sixteen-slice MDCT is useful in patients affected by DCM. However, technical limitations, such as cardiac arrhythmias, an inability of patients to sustain a long breath-hold, and the need of a high dose of contrast agent may limit its accuracy and widespread use.
Invasive coronary angiography (ICA) and MDCT coronary angiography were performed on 132 consecutive patients (82 men; age 63+/-11 years) affected by DCM (ejection fraction, 34+/-10%) of unknown etiology. In 2 patients (1.5%), MDCT was not feasible because of atrial fibrillation. Of the remaining 130 patients, 88 exhibited normal and 42 exhibited diseased coronary arteries in both MDCT and ICA. All patients with coronary artery disease except for 1 were correctly classified by MDCT as 1-vessel (11 cases), 2-vessel (13 cases), and 3-vessel (18 cases) disease. In the segment-based analyses, the overall feasibility for MDCT was 98.5% (1902 of 1930 segments). Segment-based and patient-based analyses for the detection of luminal stenosis of >50% and >70% were performed. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of MDCT for the detection of >50% stenosis were 98.1%, 99.9%, 98.7%, 99.8%, and 99.7%, respectively. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of MDCT for the detection of >70% stenosis were 99.5%, 98.6%, 94.1%, 99.9%, and 99.4%, respectively.
Excellent feasibility and diagnostic accuracy, combined with low invasiveness, make 64-slice MDCT an ideal imaging modality for the anatomic evaluation of coronary circulation in patients with DCM of unknown etiology.
本研究的目的是评估64层螺旋CT（MDCT）用于评估病因不明的扩张型心肌病（DCM）患者冠状动脉的安全性、可行性及诊断准确性。16层MDCT对DCM患者有用。然而，诸如心律失常、患者无法长时间屏气以及需要高剂量造影剂等技术限制可能会限制其准确性和广泛应用。
对132例病因不明的DCM患者（82例男性；年龄63±11岁，射血分数34±10%）进行了有创冠状动脉造影（ICA）和MDCT冠状动脉造影。2例患者（1.5%）因心房颤动导致MDCT不可行。在其余130例患者中，88例在MDCT和ICA检查中均显示冠状动脉正常，42例显示冠状动脉病变。除1例患者外，所有冠心病患者在MDCT检查中均被正确分类为单支血管病变（11例）、双支血管病变（13例）和三支血管病变（18例）。在基于节段的分析中，MDCT的总体可行性为98.5%（1930个节段中的1902个）。进行了基于节段和基于患者的分析以检测管腔狭窄>50%和>70%的情况。MDCT检测>50%狭窄的敏感性、特异性、阳性预测值、阴性预测值和准确性分别为98.1%、99.9%、98.7%、99.8%和99.7%。MDCT检测>70%狭窄的敏感性、特异性、阳性预测值、阴性预测值和准确性分别为99.5%、98.6%、94.1%、99.9%和99.4%。
极佳的可行性和诊断准确性，再加上低侵入性，使64层MDCT成为评估病因不明的DCM患者冠状动脉循环解剖结构的理想成像方式。
