Duke-National University of Singapore Graduate Medical School, Singapore.
J Cardiovasc Comput Tomogr. 2012 Sep-Oct;6(5):335-45. doi: 10.1016/j.jcct.2012.06.005. Epub 2012 Aug 16.
Anomalous origin and course of coronary arteries (AOCA) is a potential cause of sudden cardiac death. Coronary CT angiography (coronary CTA) enables detailed 3-dimensional visualization of AOCA. Data are limited about the diagnostic performance of noncontrast cardiac CT obtained during coronary calcium scan for detecting AOCA.
We assessed the feasibility of using noncontrast cardiac CT for detecting AOCA.
Participants had noncontrast cardiac CT and coronary CTA performed (2005-2010). Cases had AOCA as diagnosed with coronary CTA. Controls were without AOCA. Noncontrast cardiac CT images were independently evaluated for AOCA by a cardiologist and a radiologist blinded to prior AOCA diagnosis. Detection features to assist AOCA diagnosis on noncontrast cardiac CT were evaluated.
The study enrolled 54 cases and 155 controls. Sensitivity and specificity for detecting AOCA were 82% (95% CI, 69%-90%) and 90% (95% CI, 85%-94%) for observer 1, respectively, and 82% (95% CI, 69%-90%) and 85% (95% CI, 79%-90%) for observer 2, respectively. Average sensitivity and specificity were 82% and 88%, respectively. Interobserver agreement (Cohen κ) was κ = 0.65 (95% CI, 0.53-0.76). Inability to visualize the right coronary artery (RCA) origin at the right sinus significantly predicted RCA anomaly. Inability to visualize the left main coronary artery branching point into the left anterior descending coronary artery and the left circumflex coronary artery significantly predicted left coronary artery anomaly.
Noncontrast cardiac CT in conjunction with detection features has the potential for use in the diagnosis of AOCA. A prospective study is needed for validation and to determine the modality's accuracy for detecting AOCA.
冠状动脉异常起源和走行（AOCA）是心脏性猝死的潜在原因。冠状动脉 CT 血管造影（冠状动脉 CTA）可实现 AOCA 的详细三维可视化。关于在冠状动脉钙化扫描期间获得的非增强心脏 CT 用于检测 AOCA 的诊断性能的数据有限。
我们评估了使用非增强心脏 CT 检测 AOCA 的可行性。
参与者接受了非增强心脏 CT 和冠状动脉 CTA 检查（2005-2010 年）。病例组 AOCA 通过冠状动脉 CTA 诊断。对照组无 AOCA。一名心脏病专家和一名放射科医生对非增强心脏 CT 图像进行独立评估，评估人员对先前的 AOCA 诊断不知情。评估了有助于非增强心脏 CT 上 AOCA 诊断的检测特征。
本研究纳入了 54 例病例和 155 例对照。观察者 1 检测 AOCA 的敏感性和特异性分别为 82%（95%CI，69%-90%）和 90%（95%CI，85%-94%），观察者 2 分别为 82%（95%CI，69%-90%）和 85%（95%CI，79%-90%）。平均敏感性和特异性分别为 82%和 88%。观察者间一致性（Cohen κ）为 κ=0.65（95%CI，0.53-0.76）。无法在右窦可视化右冠状动脉（RCA）起源显著预测 RCA 异常。无法可视化左主干冠状动脉分支点进入前降支和左旋支显著预测左冠状动脉异常。
非增强心脏 CT 结合检测特征具有用于诊断 AOCA 的潜力。需要前瞻性研究来验证和确定该方法检测 AOCA 的准确性。
