Harvard School of Public Health, Children's Hospital Boston, Harvard Medical School, Beth Israel Deaconess Hospital, Massachusetts, USA.
Ann Intern Med. 2011 Mar 15;154(6):413-20. doi: 10.7326/0003-4819-154-6-201103150-00007.
A new radiation dose-saving technique for noninvasive coronary artery imaging with computed tomography (CT) is available.
To summarize current evidence about the ability of low-dose coronary CT angiography to rule out coronary artery disease (CAD) in symptomatic adults.
Online databases, including MEDLINE, EMBASE, and the Cochrane Library, from inception through 31 October 2010; abstract databases; gray literature; reference lists of identified articles; and experts. No language restrictions were applied.
All investigators screened and selected studies that compared prospective electrocardiography-gated coronary CT angiography with catheter coronary angiography (the reference standard) in symptomatic patients with suspected CAD.
Two investigators independently extracted patient and study protocol characteristics and rated methodological quality; differences were resolved by consensus or by a third reader. Multivariate random-effects models were used to obtain pooled estimates.
16 studies, comprising 960 patients, were found (7 studies of single-source, 64-slice CT; 4 of dual-source, 64-slice CT; 2 of single-source, 320-slice CT; 1 dual-source, 128-slice CT; 1 of single-source, 128-slice CT; and 1 of single-source, 256-slice CT). On average, 2.4% of the coronary arterial segments were of nondiagnostic image quality, and 1 or more segments were nondiagnostic in 9.5% of the patients. The patient-level sensitivity and specificity of CT angiography were 1.00 (95% CI, 0.98 to 1.00) and 0.89 (CI, 0.85 to 0.92), respectively. The pooled vessel- and segment-level estimates showed lower sensitivity and higher specificity than the patient-level estimates. Statistically significant heterogeneity was found between studies for vessel- and segment-level estimates, which seemed to be associated with body mass index and prevalence of CAD but not with CT scanner characteristics.
The small number of studies, half of which were from a single tertiary center, limits generalizability. The potential harms of the imaging tests were not well-evaluated.
Early evidence suggests that low-dose coronary CT angiography matches the sensitivity of catheter-based angiography, has low radiation exposure, and is a potentially valid alternative to catheter angiography for triaging symptomatic patients with a clinical suspicion of CAD.
None.
目前有一种新的辐射剂量节省技术，可用于非侵入性冠状动脉 CT 成像。
总结低剂量冠状动脉 CT 血管造影术在有症状成年人中排除冠状动脉疾病（CAD）的能力的现有证据。
在线数据库，包括 MEDLINE、EMBASE 和 Cochrane 图书馆，从成立到 2010 年 10 月 31 日；摘要数据库；灰色文献；已确定文章的参考文献列表；和专家。没有应用语言限制。
所有研究人员都筛选并选择了比较前瞻性心电图门控冠状动脉 CT 血管造影与导管冠状动脉造影（参考标准）的研究，这些研究在有 CAD 临床怀疑的有症状患者中进行。
两名研究人员独立提取患者和研究方案特征，并对方法学质量进行评分；通过共识或第三名读者解决分歧。使用多变量随机效应模型获得汇总估计值。
共发现 16 项研究，包括 960 名患者（7 项单源 64 层 CT 研究；4 项双源 64 层 CT 研究；2 项单源 320 层 CT 研究；1 项双源 128 层 CT 研究；1 项单源 128 层 CT 研究；1 项单源 256 层 CT 研究）。平均而言，2.4%的冠状动脉节段图像质量不佳，9.5%的患者有 1 个或多个节段图像质量不佳。CT 血管造影的患者水平敏感性和特异性分别为 1.00（95%CI，0.98 至 1.00）和 0.89（CI，0.85 至 0.92）。血管和节段水平的汇总估计值显示出比患者水平估计值更低的敏感性和更高的特异性。研究之间在血管和节段水平的估计值存在统计学显著的异质性，这种异质性似乎与体重指数和 CAD 的流行率有关，但与 CT 扫描仪的特征无关。
研究数量较少，其中一半来自单个三级中心，限制了其普遍性。成像检查的潜在危害没有得到很好的评估。
早期证据表明，低剂量冠状动脉 CT 血管造影与基于导管的血管造影的敏感性相匹配，辐射暴露低，并且可能是对有 CAD 临床怀疑的有症状患者进行分诊的导管血管造影的有效替代方法。
无。
