Hamirani Yasmin S, Isma'eel Hussain, Larijani Vahid, Drury Paul, Lim Wayland, Bevinal Manzoor, Saeed Anila, Ahmadi Nasser, Karlsberg Ronald P, Budoff Matthew J
Los Angeles Biomedical Research Institute at Harbor-UCLA, Torrance, CA, USA.
J Comput Assist Tomogr. 2010 Sep-Oct;34(5):645-51. doi: 10.1097/RCT.0b013e3181e3d0b1.
The aim of this study was to evaluate the diagnostic accuracy of nuclear stress imaging as compared with noninvasive coronary artery imaging using 64-detector row cardiac computed tomography.
Compared with invasive coronary angiography, multidetector row cardiac computed tomographic angiography (CTA) has shown promise in the accurate detection of coronary stenosis. Myocardial perfusion imaging (MPI) using single photon emission computed tomography is an established method for noninvasively assessing the functional significance of coronary stenosis. This study compared the accuracy of CTA and that of MPI in the detection of relevant lesions of coronary arteries.
One hundred twenty-two symptomatic patients (77% males) with cardiac catheterization who also underwent MPI and CTA evaluations within 6 months at 2 centers were included. Comparison of CTA for lesions causing greater than 50% and greater than 70% coronary narrowing versus respective lesions on invasive cardiac catheterization (IC) was performed. Similarly, comparison of MPI findings with greater than 50% and greater than 70% lesions on IC was done.
The per-patient sensitivity, specificity, and positive and negative predictive values in detecting greater than 50% coronary lesions on IC for CTA were 98.9%, 74.2%, 91.8%, and 95.8%, respectively; and for MPI, 56%, 38.7%, 72.9%, and 23%, respectively. The sensitivity, the specificity, and the positive and negative predictive values in detecting greater than 70% coronary lesions on IC for CTA were 89.7%, 86.4%, 92.1%, and 82.6%, respectively; and for MPI, 57.7%, 43.2%, 64.3%, and 36.5%, respectively. The prevalence of significant coronary artery disease on cardiac catheterization was 74.6% for greater than 50% stenosis and 63.9% for greater than 70% stenosis.
Compared with MPI, CTA provided important information and identified significant lesions in symptomatic intermediate- to high-risk patients. Cost-effective and prospective multicentered studies, currently underway, are needed to further establish the best use of these diagnostic tests in the evaluation of coronary artery disease.
本研究旨在评估核素心肌显像与使用64排心脏计算机断层扫描的无创冠状动脉成像相比的诊断准确性。
与有创冠状动脉造影相比，多排螺旋心脏计算机断层扫描血管造影（CTA）在准确检测冠状动脉狭窄方面已显示出前景。使用单光子发射计算机断层扫描的心肌灌注成像（MPI）是一种用于无创评估冠状动脉狭窄功能意义的既定方法。本研究比较了CTA和MPI在检测冠状动脉相关病变方面的准确性。
纳入122例有症状且接受了心脏导管检查的患者（77%为男性），这些患者在2个中心于6个月内还接受了MPI和CTA评估。将CTA检测导致冠状动脉狭窄大于50%和大于70%的病变与有创心脏导管检查（IC）上的相应病变进行比较。同样，将MPI结果与IC上大于50%和大于70%的病变进行比较。
CTA检测IC上大于50%冠状动脉病变时，每位患者的敏感性、特异性、阳性和阴性预测值分别为98.9%、74.2%、91.8%和95.8%；而MPI的相应值分别为56%、38.7%、72.9%和23%。CTA检测IC上大于70%冠状动脉病变时，敏感性、特异性、阳性和阴性预测值分别为89.7%、86.4%、92.1%和82.6%；而MPI的相应值分别为57.7%、43.2%、64.3%和36.5%。心脏导管检查中显著冠状动脉疾病的患病率，对于大于50%的狭窄为74.6%，对于大于70%的狭窄为63.9%。
与MPI相比，CTA为有症状的中高危患者提供了重要信息并识别出显著病变。目前正在进行的具有成本效益的前瞻性多中心研究，需要进一步确定这些诊断测试在评估冠状动脉疾病中的最佳应用。
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