Center for Medical Imaging - North East Netherlands, Department of Radiology, University of Groningen/University Medical Center Groningen, Hanzeplein 1, P.O. Box 30001, 9700 RB, Groningen, The Netherlands.
Eur Radiol. 2012 Dec;22(12):2688-98. doi: 10.1007/s00330-012-2551-x. Epub 2012 Jul 15.
A systematic review and meta-analysis to assess sensitivity and specificity of coronary CT angiography (CCTA) for significant stenosis at different degrees of coronary calcification.
A literature search was performed including studies describing test characteristics of CCTA for significant stenosis, performed with at least 16-MDCT and according to calcium score (CS). Invasive coronary angiography was the reference standard. Pooled sensitivity and specificity of CCTA by CS categories and CT equipment were calculated.
Of 14,121 articles, 51 studies reported on the impact of calcium scoring on diagnostic performance of CCTA and could be included in the systematic review. Twenty-seven of these studies (5,203 participants) were suitable for meta-analysis. On a patient-basis, sensitivity of CCTA for significant stenosis was 95.8, 95.6, 97.6 and 99.0% for CS 0-100, 101-400, 401-1,000 and >1,000 respectively. Specificity was 91.2, 88.2, 50.6 and 84.0% respectively. Specificity of CCTA was significantly lower for CS 401-1,000 due to lack of patients without significant stenosis. Sensitivity and specificity of 16-MDCT were significantly lower compared to more modern CT systems.
Even in cases of severe coronary calcification, sensitivity and specificity of CCTA for significant stenosis are high. With 64-MDCT and newer CT systems, a CS cut-off for performing CCTA no longer seems indicated.
Decisions about performing coronary CT angiography (CCTA) sometimes depend on calcium scoring. CCTA is highly sensitive for coronary stenosis. With 16-MDCT, however, heavy calcification reduces specificity for significant stenosis. For 64-MDCT (and above), CCTA has high specificity, even with severe coronary calcification.
系统评价和荟萃分析评估冠状动脉 CT 血管造影（CCTA）在不同程度冠状动脉钙化下对显著狭窄的敏感性和特异性。
检索描述 CCTA 对显著狭窄的检测特征的文献，这些研究均采用至少 16-MDCT 并根据钙评分（CS）进行。以冠状动脉造影为参考标准。根据 CS 分类和 CT 设备计算 CCTA 的汇总敏感性和特异性。
在 14121 篇文章中，有 51 篇研究报道了钙评分对 CCTA 诊断性能的影响，可纳入系统评价。其中 27 项研究（5203 名患者）适合进行荟萃分析。基于患者，CCTA 对显著狭窄的敏感性分别为 CS0-100、101-400、401-1000 和>1000 时为 95.8%、95.6%、97.6%和 99.0%。特异性分别为 91.2%、88.2%、50.6%和 84.0%。由于没有无显著狭窄的患者，CS401-1000 时 CCTA 的特异性显著降低。16-MDCT 的敏感性和特异性明显低于更现代的 CT 系统。
即使在严重冠状动脉钙化的情况下，CCTA 对显著狭窄的敏感性和特异性也很高。使用 64-MDCT 和更新的 CT 系统，进行 CCTA 的 CS 截断似乎不再适用。
关于进行冠状动脉 CT 血管造影（CCTA）的决策有时取决于钙评分。CCTA 对冠状动脉狭窄具有高度敏感性。然而，对于 16-MDCT，重度钙化会降低对显著狭窄的特异性。对于 64-MDCT（及以上），即使存在严重的冠状动脉钙化，CCTA 也具有较高的特异性。
