Department of Cardiology, Lillebaelt Hospital, Kabbeltoft 25, DK-7100 Vejle, Denmark.
J Cardiovasc Comput Tomogr. 2010 May-Jun;4(3):186-94. doi: 10.1016/j.jcct.2010.03.010. Epub 2010 Mar 31.
A high diagnostic performance of coronary computed tomographic angiography (CTA) in identifying coronary artery disease (CAD) has been shown in experienced high-volume centers. Whether this may be accomplished in centers with less CTA experience remains unknown.
We determined the diagnostic performance and interobserver reproducibility of CTA in detecting significant CAD in a center with limited experience.
In 209 patients, CTA was performed with 64-slice or dual-source CT technology, and analyses were performed independently by 2 inexperienced observers. Significant CAD by CTA was defined as >/=1 stenoses >/=50% or >/=1 nonevaluable segment, whereas significant CAD by invasive quantitative coronary angiography was defined as >/=1 stenoses >/=50%. We evaluated the influence of CAD pretest probability, Agatston score (AS), heart rate (HR), and observer experience on the diagnostic sensitivity, specificity, positive (PPV) and negative predictive values (NPV), interobserver reproducibility, and duration of CTA analysis.
Per-patient (CAD prevalence, 35%) sensitivity was 88%-99%, specificity was 78%-82%, PPV was 68%-74%, and NPV was 92%-99%. Overall interobserver reproducibility was good (kappa = 0.65). A significant temporal improvement was observed in diagnostic specificity (observer A: 68%-89%, P = 0.007; observer B: 71%-89%, P = 0.02), and interobserver reproducibility (kappa = 0.35-0.89, P = 0.01) during the study period. Duration of analysis decreased during the study period and was positively associated with CAD pretest probability and AS.
Suboptimal diagnostic performance and interobserver reproducibility must be anticipated during CTA implementation. A high diagnostic sensitivity, specificity, and interobserver reproducibility were achieved after a large number of studies performed with the state-of-the-art scanner technology.
在经验丰富的大容量中心，冠状动脉计算机断层血管造影（CTA）在识别冠状动脉疾病（CAD）方面具有较高的诊断性能。但在经验较少的中心是否能达到这种效果仍不清楚。
我们在一个经验有限的中心，确定 CTA 在检测有意义的 CAD 中的诊断性能和观察者间可重复性。
在 209 例患者中，采用 64 层或双源 CT 技术进行 CTA，由 2 名无经验的观察者独立进行分析。CTA 诊断的有意义的 CAD 定义为> = 1 处狭窄程度> = 50%或> = 1 处无法评估的节段，而定量冠状动脉造影的有意义的 CAD 定义为> = 1 处狭窄程度> = 50%。我们评估了 CAD 预测概率、Agatston 评分（AS）、心率（HR）和观察者经验对诊断敏感性、特异性、阳性预测值（PPV）和阴性预测值（NPV）、观察者间可重复性和 CTA 分析时间的影响。
每位患者（CAD 患病率 35%）的敏感性为 88%-99%，特异性为 78%-82%，PPV 为 68%-74%，NPV 为 92%-99%。整体观察者间可重复性较好（kappa = 0.65）。在研究期间，诊断特异性（观察者 A：68%-89%，P = 0.007；观察者 B：71%-89%，P = 0.02）和观察者间可重复性（kappa = 0.35-0.89，P = 0.01）均有显著提高。分析时间在研究期间减少，并与 CAD 预测概率和 AS 呈正相关。
在 CTA 实施期间，预计会出现诊断性能不佳和观察者间可重复性差的情况。在使用最先进的扫描仪技术进行大量研究后，实现了较高的诊断敏感性、特异性和观察者间可重复性。
