Istituto di Radiologia, Azienda Ospedaliero Universitaria Integrata di Verona Policlinico G.B. Rossi, Piazzzale L.A. Scuro 10, Verona, Italy.
Radiol Med. 2012 Sep;117(6):939-52. doi: 10.1007/s11547-012-0842-6. Epub 2012 Jun 28.
The authors sought to evaluate the incremental value of introducing coronary angiography with multidetector computed tomography (MDCT-CA) compared with the conventional diagnostic workup in managing patients with suspected coronary artery disease (CAD) workup.
A total of 531 consecutive patients underwent MDCT-CA between April 2008 and August 2010. For each patient the pretest probability of CAD was obtained by using the Morise score as well as the diagnostic performance of the exercise test and of MDCT-CA, considering conventional coronary angiography (CCA) as the gold standard. Based on these results, we calculated the posttest likelihood of CAD after stress testing, comparing the incremental diagnostic value for each category of cardiovascular risk with data obtained with MDCT-CA. The conventional diagnostic workup (without MDCT-CA) was then compared with the modified workup (including MDCT-CA).
The diagnostic performance of the exercise test for identifying patients with significant lesions had a sensitivity and specificity of 20% and 88%, respectively, with positive (PPV) and negative (NPV) predictive value of 41% and 72%, respectively. Taking CA as the gold standard, MDCT-CA had 93% sensitivity, 89% specificity, 88% PPV and 93% NPV compared with CCA in evaluating significant stenoses in the per-patient analysis. The overall diagnostic accuracy of MDCT-CA was 91%. The exercise tests provided no significant incremental diagnostic value compared with cardiovascular history in patients with a low to intermediate risk. Comparison of the diagnostic accuracy of these protocols showed improved performance results for the modified protocol.
MDCT-CA is the reference modality for the noninvasive exclusion of critical CAD. It provides a very high incremental diagnostic value compared with exercise testing in patients with a low to intermediate risk of CAD. The use of diagnostic protocols based on MDCT-CA ensures improved diagnostic performance compared with those involving conventional exercise electrocardiograms.
作者旨在评估与传统诊断程序相比，多排螺旋 CT 冠状动脉造影（MDCT-CA）在疑似冠心病（CAD）患者诊断中的附加价值。
2008 年 4 月至 2010 年 8 月，共 531 例连续患者接受了 MDCT-CA 检查。每位患者的 CAD 术前概率通过 Morise 评分获得，以及运动试验和 MDCT-CA 的诊断性能，以常规冠状动脉造影（CCA）作为金标准。基于这些结果，我们计算了运动试验后的 CAD 后验概率，比较了每种心血管风险类别的增量诊断价值与 MDCT-CA 获得的数据。然后将常规诊断程序（不包括 MDCT-CA）与改良诊断程序（包括 MDCT-CA）进行比较。
运动试验对识别有意义病变的患者的诊断性能具有 20%的敏感性和 88%的特异性，阳性（PPV）和阴性（NPV）预测值分别为 41%和 72%。以 CA 作为金标准，在评估每位患者的显著狭窄方面，MDCT-CA 与 CCA 相比，具有 93%的敏感性、89%的特异性、88%的 PPV 和 93%的 NPV。MDCT-CA 的总体诊断准确性为 91%。与心血管病史相比，运动试验在低至中度风险患者中提供的附加诊断价值无显著差异。这些方案的诊断准确性比较表明，改良方案的性能结果有所改善。
MDCT-CA 是排除严重 CAD 的非侵入性首选方法。与低至中度 CAD 风险患者的运动试验相比，MDCT-CA 提供了非常高的附加诊断价值。与涉及常规运动心电图的诊断方案相比，使用基于 MDCT-CA 的诊断方案可确保诊断性能的提高。
