Department of Cardiology, Leiden University Medical Centre, Leiden, The Netherlands.
Eur Heart J. 2011 Mar;32(5):637-45. doi: 10.1093/eurheartj/ehq395. Epub 2010 Oct 29.
The positive predictive value of multidetector computed tomography angiography (CTA) for detecting significant stenosis remains limited. Possibly CTA may be more accurate in the evaluation of atherosclerosis rather than in the evaluation of stenosis severity. However, a comprehensive assessment of the diagnostic performance of CTA in comparison with both conventional coronary angiography (CCA) and intravascular ultrasound (IVUS) is lacking. Therefore, the aim of the study was to systematically investigate the diagnostic performance of CTA for two endpoints, namely detecting significant stenosis (using CCA as the reference standard) vs. detecting the presence of atherosclerosis (using IVUS as the reference of standard).
A total of 100 patients underwent CTA followed by both CCA and IVUS. Only those segments in which IVUS imaging was performed were included for CTA and quantitative coronary angiography (QCA) analysis. On CTA, each segment was evaluated for significant stenosis (defined as ≥ 50% luminal narrowing), on CCA significant stenosis was defined as a stenosis ≥ 50%. Second, on CTA, each segment was evaluated for atherosclerotic plaque; atherosclerosis on IVUS was defined as a plaque burden of ≥ 40% cross-sectional area. CTA correctly ruled out significant stenosis in 53 of 53 (100%) patients. However, nine patients (19%) were incorrectly diagnosed as having significant lesions on CTA resulting in sensitivity, specificity, positive, and negative predictive values of 100, 85, 81, and 100%. CTA correctly ruled out the presence of atherosclerosis in 7 patients (100%) and correctly identified the presence of atherosclerosis in 93 patients (100%). No patients were incorrectly classified, resulting in sensitivity, specificity, positive, and negative predictive values of 100%. Conclusions The present study is the first to confirm using both CCA and IVUS that the diagnostic performance of CTA is superior in the evaluation of the presence or the absence of atherosclerosis when compared with the evaluation of significant stenosis.
多排螺旋 CT 血管造影（CTA）检测显著狭窄的阳性预测值仍然有限。CTA 可能更擅长评估动脉粥样硬化，而不是评估狭窄严重程度。然而，缺乏 CTA 与传统冠状动脉造影（CCA）和血管内超声（IVUS）的诊断性能的综合评估。因此，本研究的目的是系统地研究 CTA 在检测两个终点（即使用 CCA 作为参考标准检测显著狭窄与使用 IVUS 作为参考标准检测动脉粥样硬化的存在）方面的诊断性能。
共 100 例患者接受 CTA 检查，然后进行 CCA 和 IVUS 检查。只有进行 IVUS 成像的节段才被纳入 CTA 和定量冠状动脉造影（QCA）分析。在 CTA 上，每个节段都评估是否存在显著狭窄（定义为管腔狭窄≥50%），在 CCA 上，狭窄程度≥50%被定义为显著狭窄。其次，在 CTA 上，每个节段都评估动脉粥样硬化斑块；IVUS 上的动脉粥样硬化定义为斑块负荷≥40%的横截面积。CTA 正确排除了 53 例（100%）患者的显著狭窄。然而，有 9 例（19%）患者被错误地诊断为 CTA 存在显著病变，导致敏感性、特异性、阳性预测值和阴性预测值分别为 100%、85%、81%和 100%。CTA 正确排除了 7 例（100%）患者的动脉粥样硬化存在，并正确识别了 93 例（100%）患者的动脉粥样硬化存在。没有患者被错误分类，导致敏感性、特异性、阳性预测值和阴性预测值分别为 100%。
本研究首次使用 CCA 和 IVUS 证实，与评估显著狭窄相比，CTA 在评估动脉粥样硬化的存在或不存在方面的诊断性能更好。
