Department of Radiology and Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands.
Radiol Med. 2011 Dec;116(8):1174-87. doi: 10.1007/s11547-011-0722-5. Epub 2011 Sep 2.
We evaluated the multislice computed tomography (MSCT) coronary plaque burden in patients with stable and unstable angina pectoris.
Twenty-one patients with stable and 20 with unstable angina pectoris scheduled for conventional coronary angiography (CCA) underwent MSCT-CA using a 64-slice scanner offering a fast rotation time (330 ms) and higher X-ray tube output (900 mAs). To determine the MSCT coronary plaque burden, we assessed the extent (number of diseased segments), size (small or large), type (calcific, noncalcific, mixed) of plaque, its anatomic distribution and angiographic appearance in all available ≥2-mm segments. In a subset of 15 (seven stable, eight unstable) patients, the detection and classification of coronary plaques by MSCT was verified by intracoronary ultrasound (ICUS).
Sensitivity and specificity of MSCT compared with ICUS to detect significant plaques (defined as ≥1-mm plaque thickness on ICUS) was 83% and 87%. Overall, 473 segments were examined, resulting in 11.6±1.5 segments per patient. Plaques were present in 62% of segments and classified as large in 47% of diseased segments. Thirty-two percent were noncalcific, 25% calcific and 43% mixed. Plaques were most frequently located in the proximal and mid segments. Plaque was found in 33% of segments classified as normal on CCA. Unstable patients had significantly more noncalcific plaques when compared with stable patients (45% vs. 21%, p<0.05).
MSCT-CA provides important information regarding the coronary plaque burden in patients with stable and unstable angina.
我们评估了稳定型和不稳定型心绞痛患者的多层螺旋 CT（MSCT）冠状动脉斑块负荷。
21 例稳定型心绞痛患者和 20 例不稳定型心绞痛患者接受了 64 层螺旋 CT 冠状动脉造影（MSCT-CA）检查，使用快速旋转时间（330 毫秒）和高 X 射线管输出（900 mAs）的扫描仪。为了确定 MSCT 冠状动脉斑块负荷，我们评估了斑块的程度（病变节段数）、大小（小或大）、类型（钙化、非钙化、混合）、解剖分布和所有可获得的≥2mm 节段的血管造影表现。在 15 例（7 例稳定型，8 例不稳定型）患者的亚组中，通过冠状动脉内超声（ICUS）验证了 MSCT 对冠状动脉斑块的检测和分类。
MSCT 与 ICUS 相比，检测有意义斑块（定义为 ICUS 上≥1mm 斑块厚度）的敏感性和特异性分别为 83%和 87%。总体上，检查了 473 个节段，每个患者有 11.6±1.5 个节段。62%的节段存在斑块，47%的病变节段为大斑块。32%为非钙化斑块，25%为钙化斑块，43%为混合斑块。斑块最常位于近段和中段。在 CCA 分类为正常的节段中，有 33%发现了斑块。与稳定型患者相比，不稳定型患者的非钙化斑块明显更多（45%比 21%，p<0.05）。
MSCT-CA 为稳定型和不稳定型心绞痛患者的冠状动脉斑块负荷提供了重要信息。
