Zhang Long-Jiang, Wu Sheng-Yong, Wang Jing, Lu Ying, Zhang Zhuo-Li, Jiang Shi-Sen, Zhou Chang-Sheng, Lu Guang-Ming
Department of Medical Imaging, Jinling Hospital, Clinical School of Medical College, Nanjing University, China.
Acta Radiol. 2010 Sep;51(7):727-40. doi: 10.3109/02841851.2010.492792.
Dual-source CT coronary angiography (CTCA) has been used to detect coronary artery disease; however, the factors with potential to affect its diagnostic accuracy remain to be defined.
To prospectively evaluate the accuracy of dual-source CTCA in diagnosing coronary artery stenosis according to conventional coronary angiography (CAG), and the effect of average heart rate, heart rate variability, and calcium score on the accuracy of CTCA.
A total of 113 patients underwent both dual-source CTCA and CAG. The results were used to evaluate the findings in dual-source CTCA to assess the accuracy in the diagnosis of > or =50% (significant stenosis) and >75% (severe stenosis) of coronary artery according to those by CAG. Patients were divided into subgroups according to their heart rate (HR), HR variability (HRV), and calcium score, and the accuracy of CTCA was further evaluated. The chi-square test was used to analyze the difference in sensitivity and specificity for the detection of > or =50% and >75% coronary stenosis among subgroups. The generalized estimation equation method was used in per-vessel analysis to adjust for within-patient correlation.
In all, 113 patients had 338 vessels and 1661 segments evaluated by CAG. Dual-source CTCA displayed 1527 segments (91.9%). Among them, 1468 segments (calcium score by CAG score 1, n=1018; score 2, n=270; score 3, n=180) were assessable in CTCA. On a per-patient analysis, the sensitivity and specificity of CTCA were 93.9% and 93.5% for significant stenosis and 86.9% and 98.1% for severe stenosis. On a per-vessel basis, the sensitivity and specificity were 90.2% and 97.1% for significant and 83.3% and 98.1% for severe stenosis. On a per-segment analysis, the sensitivity and specificity were 90.2% and 97.1% for significant and 83.3% and 98.1% for severe stenosis. Average HR had no effect on the sensitivity and specificity of CTCA (P>0.05); whereas HRV and calcium score had some effect on the sensitivity and specificity of CTCA (P<0.05).
On a per-patient, per-vessel, and per-segment basis, dual-source CTCA has a high sensitivity and specificity for the diagnosis of coronary artery stenosis. Average HR has no effect on the diagnostic accuracy of CTCA, while HRV and calcium score have a statistically significant effect on the sensitivity and specificity of CTCA.
双源CT冠状动脉造影（CTCA）已用于检测冠状动脉疾病；然而，可能影响其诊断准确性的因素仍有待确定。
根据传统冠状动脉造影（CAG）前瞻性评估双源CTCA诊断冠状动脉狭窄的准确性，以及平均心率、心率变异性和钙化积分对CTCA准确性的影响。
113例患者同时接受了双源CTCA和CAG检查。结果用于评估双源CTCA的检查结果，以根据CAG评估诊断冠状动脉≥50%（显著狭窄）和>75%（严重狭窄）的准确性。根据心率（HR）、HR变异性（HRV）和钙化积分将患者分为亚组，并进一步评估CTCA的准确性。采用卡方检验分析亚组间检测冠状动脉≥50%和>75%狭窄的敏感性和特异性差异。在每支血管分析中采用广义估计方程法来校正患者内相关性。
总共113例患者的338支血管和1661节段接受了CAG评估。双源CTCA显示了1527节段（91.9%）。其中，1468节段（CAG钙化积分1分，n = 1018；2分，n = 270；3分，n = 180）在CTCA中可评估。在每位患者分析中，CTCA对显著狭窄的敏感性和特异性分别为93.9%和93.5%，对严重狭窄的敏感性和特异性分别为86.9%和98.1%。在每支血管基础上，显著狭窄的敏感性和特异性分别为90.2%和97.1%，严重狭窄的敏感性和特异性分别为83.3%和98.1%。在每节段分析中，显著狭窄的敏感性和特异性分别为90.2%和97.1%，严重狭窄的敏感性和特异性分别为83.3%和98.1%。平均HR对CTCA的敏感性和特异性无影响（P>0.05）；而HRV和钙化积分对CTCA的敏感性和特异性有一定影响（P<0.05）。
在每位患者、每支血管和每节段基础上，双源CTCA对冠状动脉狭窄的诊断具有较高的敏感性和特异性。平均HR对CTCA的诊断准确性无影响，而HRV和钙化积分对CTCA的敏感性和特异性有统计学显著影响。
