Division of Cardiovascular Medicine, Kettering Medical Center, Kettering, Ohio 42429, USA.
J Am Coll Radiol. 2012 Sep;9(9):630-4. doi: 10.1016/j.jacr.2012.04.016.
Coronary CT angiography (CCTA) is a relatively new technique whose role has yet to be fully defined. The initial appropriateness criteria (AC) guidelines published in 2006 have already been revised. There is paucity of data on the effect of the AC on the use of CCTA at academic centers and none for the private sector.
All CCTA studies ordered at one institution (a large community hospital with internal medicine and cardiovascular training programs) from 2006 to 2008 were retrospectively evaluated, and the ordering indications were categorized per the published AC for both 2006 and 2010.
There were 384 studies, of which 243 were included in this study. The majority of the studies were ordered for chest pain (67.1% of patients). A significant proportion of studies (43.2%) were classified as inappropriate on the basis of the 2006 published criteria. Uncertain indications made up 39.1%, and appropriate indications were a minority. There was a significant regrading of appropriateness using the 2010 guidelines. Inappropriate testing remained similar at 48.1%, but uncertain cases decreased to only 2.8%, while appropriateness increased to 49.0% (P = .0001 for trend).
The updated 2010 AC guidelines for CCTA resulted in a significant reclassification of the indications for ordering CCTA from the previous 2006 guidelines. This shift in the AC reflects increased familiarity and confidence with this new technology across the imaging community. A large proportion of CCTA studies were ordered for inappropriate indications using both sets of criteria. Further research and enhanced education are needed to disseminate the appropriate role of CCTA in cardiovascular imaging.
冠状动脉 CT 血管造影（CCTA）是一种相对较新的技术，其作用尚未完全确定。2006 年发布的最初适宜性标准（AC）指南已经过修订。关于 AC 对学术中心和私营部门使用 CCTA 的影响的数据很少。
回顾性评估了一家机构（一家拥有内科和心血管培训项目的大型社区医院）在 2006 年至 2008 年期间所有的 CCTA 研究，根据 2006 年和 2010 年发布的 AC，对每个研究的订单指征进行了分类。
共有 384 项研究，其中 243 项被纳入本研究。大多数研究是为胸痛（67.1%的患者）而进行的。根据 2006 年发布的标准，有相当一部分（43.2%）研究被归类为不适当。不确定的指征占 39.1%，而适当的指征则较少。使用 2010 年指南进行了适当性的重新分级。不适当的检查仍然相似，为 48.1%，但不确定的病例减少到只有 2.8%，而适当性增加到 49.0%（趋势 P =.0001）。
更新的 2010 年 CCTA AC 指南导致 CCTA 订单指征与之前的 2006 年指南相比发生了显著的重新分类。AC 的这种变化反映了影像学界对这项新技术的熟悉程度和信心的提高。使用这两种标准，都有很大一部分 CCTA 研究是为不适当的指征而进行的。需要进一步的研究和强化教育，以传播 CCTA 在心血管成像中的适当作用。
