一项用于比较 MR 和 CT 成像检测冠状动脉狭窄的前瞻性研究。

A prospective study for comparison of MR and CT imaging for detection of coronary artery stenosis.

机构信息

Department of Internal Medicine/Cardiology, Deutsches Herzzentrum Berlin, Berlin, Germany.

出版信息

JACC Cardiovasc Imaging. 2011 Jan;4(1):50-61. doi: 10.1016/j.jcmg.2010.10.007.

DOI:10.1016/j.jcmg.2010.10.007

PMID:21232704

Abstract

OBJECTIVES

the purpose of the present study was to directly compare the diagnostic accuracy of magnetic resonance imaging (MRI) and multislice computed tomography (CT) for the detection of coronary artery stenosis.

BACKGROUND

both imaging modalities have emerged as potential noninvasive coronary imaging modalities; however, CT-unlike MRI-exposes patients to radiation and iodinated contrast agent.

METHODS

one hundred twenty consecutive patients with suspected or known coronary artery disease prospectively underwent 32-channel 3.0-T MRI and 64-slice CT before elective X-ray angiography. The diagnostic accuracy of the 2 modalities for detecting significant coronary stenosis (≥ 50% luminal diameter stenosis) in segments ≥ 1.5 mm diameter was compared with quantitative invasive coronary angiography as the reference standard.

RESULTS

in the patient-based analysis MRI and CT angiography showed similar diagnostic accuracy of 83% (95% confidence interval [CI]: 75 to 87) versus 87% (95% CI: 80 to 92), p = 0.38; sensitivity of 87% (95% CI: 76 to 93) versus 90% (95% CI: 80 to 95), p = 0.16; and specificity of 77% (95% CI: 63 to 87) versus 83% (95% CI: 70 to 91), p = 0.06, respectively. All cases of left main or 3-vessel disease were correctly diagnosed by MRI and CT angiography. In the patient-based analysis MRI and CT angiography were similar in their ability to identify patients who subsequently underwent revascularization: the area under the receiver-operator characteristic curve was 0.78 (95% CI: 0.69 to 0.87) for MRI and 0.82 (95% CI: 0.74 to 0.90) for CT angiography.

CONCLUSIONS

thirty-two channel 3.0-T MRI and 64-slice CT angiography similarly identify significant coronary stenosis in patients with suspected or known coronary artery disease scheduled for elective coronary angiography. However, CT angiography showed a favorable trend toward higher diagnostic performance.

摘要

目的

本研究旨在直接比较磁共振成像（MRI）和多层螺旋 CT（CT）检测冠状动脉狭窄的诊断准确性。

背景

这两种成像方式均已成为潜在的非侵入性冠状动脉成像方式；然而，CT 与 MRI 不同，它会使患者暴露于辐射和碘造影剂下。

方法

120 例疑似或已知冠心病患者前瞻性地在选择性 X 射线血管造影前行 32 通道 3.0-T MRI 和 64 层 CT。以定量有创冠状动脉造影为参考标准，比较两种方法检测直径≥1.5mm 节段≥50%管腔狭窄的显著冠状动脉狭窄（狭窄程度≥50%）的诊断准确性。

结果

基于患者的分析，MRI 和 CT 血管造影显示出相似的诊断准确性，分别为 83%（95%置信区间：75%至 87%）与 87%（95%置信区间：80%至 92%），p=0.38；敏感性分别为 87%（95%置信区间：76%至 93%）与 90%（95%置信区间：80%至 95%），p=0.16；特异性分别为 77%（95%置信区间：63%至 87%）与 83%（95%置信区间：70%至 91%），p=0.06。所有左主干或 3 支血管疾病的病例均被 MRI 和 CT 血管造影正确诊断。在基于患者的分析中，MRI 和 CT 血管造影在识别随后接受血运重建的患者方面具有相似的能力：MRI 的受试者工作特征曲线下面积为 0.78（95%置信区间：0.69 至 0.87），CT 血管造影为 0.82（95%置信区间：0.74 至 0.90）。