应用射频背向散射血管内超声作为参考标准对中等程度冠状动脉病变进行标准化、三维、定量冠状动脉计算机断层扫描斑块测量的前瞻性验证：来自 ATLANTA（应用血流储备分数、血管内超声和虚拟组织学以及动脉粥样斑块无创计算机断层扫描评估组织特征、病变形态和血流动力学）I 研究的结果。

Prospective validation of standardized, 3-dimensional, quantitative coronary computed tomographic plaque measurements using radiofrequency backscatter intravascular ultrasound as reference standard in intermediate coronary arterial lesions: results from the ATLANTA (assessment of tissue characteristics, lesion morphology, and hemodynamics by angiography with fractional flow reserve, intravascular ultrasound and virtual histology, and noninvasive computed tomography in atherosclerotic plaques) I study.

机构信息

Piedmont Heart Institute, Atlanta, Georgia 30309, USA.

出版信息

JACC Cardiovasc Interv. 2011 Feb;4(2):198-208. doi: 10.1016/j.jcin.2010.10.008.

DOI:10.1016/j.jcin.2010.10.008

PMID:21349459

Abstract

OBJECTIVES

This study sought to determine the accuracy of 3-dimensional, quantitative measurements of coronary plaque by computed tomography angiography (CTA) against intravascular ultrasound with radiofrequency backscatter analysis (IVUS/VH).

BACKGROUND

Quantitative, 3-dimensional coronary CTA plaque measurements have not been validated against IVUS/VH.

METHODS

Sixty patients in a prospective study underwent coronary X-ray angiography, IVUS/VH, and coronary CTA. Plaque geometry and composition was quantified after spatial coregistration on segmental and slice-by-slice bases. Correlation, mean difference, and limits of agreement were determined.

RESULTS

There was significant correlation for all pre-specified parameters by segmental and slice-by-slice analyses (r = 0.41 to 0.84; all p < 0.001). On a segmental basis, CTA underestimated minimal lumen diameter by 21% and overestimated diameter stenosis by 39%. Minimal lumen area was overestimated on CTA by 27% but area stenosis was only underestimated by 5%. Mean difference in noncalcified plaque volume and percent and calcified plaque volume and percent were 38%, -22%, 104%, and 64%. On a slice-by-slice basis, lumen, vessel, noncalcified-, and calcified-plaque areas were overestimated on CTA by 22%, 19%, 44%, and 88%. There was significant correlation for percentage of atheroma volume (0.52 vs. 0.54; r = 0.51; p < 0.001). Compositional analysis suggested that high-density noncalcified plaque on CTA best correlated with fibrous tissue and low-density noncalcified plaque correlated with necrotic core plus fibrofatty tissue by IVUS/VH.

CONCLUSIONS

This is the first validation that standardized, 3-dimensional, quantitative measurements of coronary plaque correlate with IVUS/VH. Mean differences are small, whereas limits of agreement are wide. Low-density noncalcified plaque correlates with necrotic core plus fibrofatty tissue on IVUS/VH.

摘要

目的

本研究旨在通过与血管内超声（IVUS）联合射频背向散射分析（VH）比较，确定冠状动脉 CT 血管造影（CTA）对冠状动脉斑块进行三维定量测量的准确性。

背景

冠状动脉 CTA 斑块的定量三维测量尚未经过 IVUS/VH 验证。

方法

前瞻性研究纳入 60 例患者，进行冠状动脉 X 射线血管造影、IVUS/VH 和冠状动脉 CTA 检查。在基于节段和逐层的空间配准后，对斑块的几何形状和成分进行定量。确定相关性、平均差值和一致性界限。

结果

基于节段和逐层分析，所有指定的参数均具有显著相关性（r=0.41 至 0.84；所有 p<0.001）。在节段基础上，CTA 低估最小管腔直径 21%，高估直径狭窄率 39%。CTA 高估最小管腔面积 27%，但仅低估面积狭窄率 5%。非钙化斑块体积和百分比以及钙化斑块体积和百分比的平均差值分别为 38%、-22%、104%和 64%。基于逐层分析，CTA 高估管腔、血管、非钙化斑块和钙化斑块面积分别为 22%、19%、44%和 88%。粥样斑块体积百分比具有显著相关性（0.52 比 0.54；r=0.51；p<0.001）。成分分析表明，CTA 上的高密度非钙化斑块与纤维组织相关性最好，而低密度非钙化斑块与 IVUS/VH 上的坏死核心加纤维脂肪组织相关性最好。