Department of Cardiology, Johns Hopkins Hospital, Baltimore, MD 21287, USA.
Radiology. 2011 Oct;261(1):100-8. doi: 10.1148/radiol.11110537. Epub 2011 Aug 9.
To evaluate the influence of cross-sectional arc calcification on the diagnostic accuracy of computed tomography (CT) angiography compared with conventional coronary angiography for the detection of obstructive coronary artery disease (CAD).
Institutional Review Board approval and written informed consent were obtained from all centers and participants for this HIPAA-compliant study. Overall, 4511 segments from 371 symptomatic patients (279 men, 92 women; median age, 61 years [interquartile range, 53-67 years]) with clinical suspicion of CAD from the CORE-64 multicenter study were included in the analysis. Two independent blinded observers evaluated the percentage of diameter stenosis and the circumferential extent of calcium (arc calcium). The accuracy of quantitative multidetector CT angiography to depict substantial (≥ 50%) stenoses was assessed by using quantitative coronary angiography (QCA). Cross-sectional arc calcium was rated on a segment level as follows: noncalcified or mild (< 90°), moderate (90°-180°), or severe (> 180°) calcification. Univariable and multivariable logistic regression, receiver operation characteristic curve, and clustering methods were used for statistical analyses.
A total of 1099 segments had mild calcification, 503 had moderate calcification, 338 had severe calcification, and 2571 segments were noncalcified. Calcified segments were highly associated (P < .001) with disagreement between CTA and QCA in multivariable analysis after controlling for sex, age, heart rate, and image quality. The prevalence of CAD was 5.4% in noncalcified segments, 15.0% in mildly calcified segments, 27.0% in moderately calcified segments, and 43.0% in severely calcified segments. A significant difference was found in area under the receiver operating characteristic curves (noncalcified: 0.86, mildly calcified: 0.85, moderately calcified: 0.82, severely calcified: 0.81; P < .05).
In a symptomatic patient population, segment-based coronary artery calcification significantly decreased agreement between multidetector CT angiography and QCA to detect a coronary stenosis of at least 50%.
评估横断面弧形钙化对计算机断层扫描（CT）血管造影术诊断阻塞性冠状动脉疾病（CAD）的影响，与传统冠状动脉造影术相比。
该 HIPAA 合规研究获得了所有中心和参与者的机构审查委员会批准和书面知情同意。共有来自 CORE-64 多中心研究的 371 例有 CAD 临床可疑症状的患者（279 名男性，92 名女性；中位年龄 61 岁[四分位间距 53-67 岁]）的 4511 个节段被纳入分析。两名独立的盲法观察者评估了直径狭窄的百分比和钙的环形范围（弧形钙）。定量多排 CT 血管造影术对描绘实质性（≥50%）狭窄的准确性通过定量冠状动脉造影术（QCA）进行评估。横断面弧形钙在节段水平上的评分如下：无钙化或轻度（<90°）、中度（90°-180°）或重度（>180°）钙化。使用单变量和多变量逻辑回归、接收者操作特征曲线和聚类方法进行统计分析。
共有 1099 个节段有轻度钙化，503 个节段有中度钙化，338 个节段有重度钙化，2571 个节段无钙化。在多变量分析中，控制性别、年龄、心率和图像质量后，钙化节段与 CTA 和 QCA 之间的不一致性高度相关（P<.001）。非钙化节段的 CAD 患病率为 5.4%，轻度钙化节段为 15.0%，中度钙化节段为 27.0%，重度钙化节段为 43.0%。在接收者操作特征曲线下的面积方面存在显著差异（无钙化：0.86，轻度钙化：0.85，中度钙化：0.82，重度钙化：0.81；P<.05）。
在有症状的患者人群中，节段性冠状动脉钙化显著降低了多排 CT 血管造影术与 QCA 检测至少 50%的冠状动脉狭窄的一致性。
