Department of Medicine, Division of Cardiology, Weill Cornell Medical College at New York Presbyterian Hospital, 520 East 70th Street New York, NY 10021, USA.
J Cardiovasc Comput Tomogr. 2010 Nov-Dec;4(6):384-90. doi: 10.1016/j.jcct.2010.08.006. Epub 2010 Sep 20.
Coronary computed tomographic angiography (CCTA) possesses high accuracy to detect coronary artery disease (CAD), although studies have reported differences in diagnostic performance. Prior trials used different numbers of interpreters, and the optimal number to detect CAD is unknown.
We compared the diagnostic performance of 1, 2, 3, and 5 randomly selected interpreters for CCTA.
We evaluated 50 patients randomly selected from 2 multicenter studies with both 64-detector CCTA and invasive quantitative coronary angiography (QCA). Five blinded, experienced readers independently interpreted CCTA and assessed for obstructive CAD (≥ 50% stenosis) and high-risk CAD (left main, proximal left anterior descending, or 3-vessel stenoses). A core laboratory performed QCA. For each patient, different random combinations of readers were selected; the accuracy of 1, 2, and 5 readers was compared with 3 readers.
Obstructive and high-risk CAD were observed in 20 of 50 (40%) and 6 of 50 (12%) patients, respectively. With combinations of 1, 2, 3, or 5 readers, there was a range of per-patient diagnostic performance (sensitivity, 100% each; specificity, 67%-90%; accuracy, 80%-94%; P = NS), per-segment diagnostic performance (sensitivity, 67%-83%; specificity, 87%-93%; accuracy, 87%-92%; P < .001 for 1 vs 3 and 2 vs 3 readers), and detection of high-risk CAD (sensitivity, 83%-100%; specificity, 73%-80%; accuracy, 76%-82%; P = NS). The highest diagnostic accuracy was observed with 3 readers for each comparison.
The diagnostic performance of CCTA to detect obstructive or high-risk CAD is generally high irrespective of the number of readers. Consensus interpretation by ≥ 3 readers provides the highest diagnostic accuracy.
冠状动脉计算机断层血管造影术（CCTA）在诊断冠状动脉疾病（CAD）方面具有较高的准确性，但研究报告显示其诊断性能存在差异。先前的试验使用了不同数量的解释者，而检测 CAD 的最佳数量尚不清楚。
我们比较了 CCTA 中 1、2、3 和 5 名随机选择的解释者的诊断性能。
我们从两项多中心研究中随机选择了 50 名患者，这些研究均进行了 64 排 CCTA 和有创定量冠状动脉造影术（QCA）。5 名独立的、经验丰富的读者对 CCTA 进行了独立解读，并评估了是否存在阻塞性 CAD（≥50%狭窄）和高危 CAD（左主干、近端左前降支或 3 支血管狭窄）。一个核心实验室进行了 QCA。为每位患者选择了不同的随机组合的读者；与 3 名读者相比，比较了 1、2 和 5 名读者的准确性。
50 名患者中分别有 20 名（40%）和 6 名（12%）患者存在阻塞性 CAD 和高危 CAD。在使用 1、2、3 或 5 名读者的组合中，每位患者的诊断性能存在一定范围（敏感性均为 100%；特异性为 67%-90%；准确性为 80%-94%；P=NS），每个节段的诊断性能（敏感性为 67%-83%；特异性为 87%-93%；准确性为 87%-92%；P<0.001 为 1 与 3 及 2 与 3 读者比较）和高危 CAD 的检测（敏感性为 83%-100%；特异性为 73%-80%；准确性为 76%-82%；P=NS）。在每项比较中，使用 3 名读者时观察到最高的诊断准确性。
CCTA 检测阻塞性或高危 CAD 的诊断性能通常较高，与读者数量无关。≥3 名读者的共识解释可提供最高的诊断准确性。
