Department of Internal Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
Can J Cardiol. 2011 Sep-Oct;27(5):606-12. doi: 10.1016/j.cjca.2010.12.026.
Numerous radiation dose reduction measures have been proposed for coronary computed tomographic angiography (CCTA). Although these techniques allow for imaging with reduced radiation, it is unknown whether diagnostic performance is maintained. A new high-definition CCTA (HD-CCTA) allows higher spatial resolution, reduced image noise, and lower radiation doses.
The aim of this study was to determine the diagnostic performance of HD-CCTA, in combination with multiple radiation dose reduction strategies, for the detection of obstructive coronary artery disease.
Consecutive patients (N = 43, aged 60 ± 10 years, 83% male) with chest pain and referred for quantitative coronary angiography (QCA) underwent HD-CCTA with radiation dose reduction measures, including prospective electrocardiographic triggering, reduction of additional tube on-time, and minimization of tube voltage and current. Intraluminal diameter stenosis ≥ 50% was considered significant. QCA served as the reference standard. The area under the receiver-operating-characteristic curve (AUC) was used to evaluate diagnostic accuracy.
All scans demonstrated diagnostic image quality, with 99% (543/548) of included coronary segments interpretable by HD-CCTA. Median effective radiation dose was 2.8 mSv (interquartile range, 1.3-3.9). The AUC for the per-patient assessment for stenosis ≥ 50% was 0.90 (95% confidence interval [CI], 0.77-0.96), with sensitivity of 95% (95% CI, 85%-100%), specificity of 79% (95% CI, 63%-95%), positive predictive value of 78% (95% CI, 61%-95%), and negative predictive value of 95% (95% CI, 85%-100%).
Compared with QCA, HD-CCTA with multiple dose reduction measures resulted in low radiation doses and high diagnostic accuracy to detect and exclude obstructive coronary artery disease.
已经提出了许多用于冠状动脉计算机断层血管造影（CCTA）的辐射剂量降低措施。尽管这些技术可以实现低辐射成像，但尚不清楚诊断性能是否得到维持。新的高清 CCTA（HD-CCTA）允许更高的空间分辨率、更低的图像噪声和更低的辐射剂量。
本研究旨在确定 HD-CCTA 与多种辐射剂量降低策略相结合，用于检测阻塞性冠状动脉疾病的诊断性能。
连续入组的 43 例胸痛患者（年龄 60±10 岁，83%为男性），进行了 HD-CCTA 检查，采用了多种辐射剂量降低措施，包括前瞻性心电图触发、减少附加管时、最小化管电压和电流。管腔直径狭窄≥50%被认为有意义。定量冠状动脉造影（QCA）作为参考标准。受试者工作特征曲线下面积（AUC）用于评估诊断准确性。
所有扫描均显示出诊断性图像质量，99%（543/548）的包含冠状动脉节段可由 HD-CCTA 进行解释。中位有效辐射剂量为 2.8 mSv（四分位间距，1.3-3.9）。每位患者评估狭窄≥50%的 AUC 为 0.90（95%置信区间，0.77-0.96），敏感度为 95%（95%置信区间，85%-100%），特异度为 79%（95%置信区间，63%-95%），阳性预测值为 78%（95%置信区间，61%-95%），阴性预测值为 95%（95%置信区间，85%-100%）。
与 QCA 相比，采用多种剂量降低措施的 HD-CCTA 可实现低辐射剂量和高诊断准确性，用于检测和排除阻塞性冠状动脉疾病。
