Sun Kai, Han Rui-Juan, Cui Li-Fang, Zhao Rui-Ping, Ma Li-Jun, Wang Li-Jun, Li Li-Gang, Li Chang-Yong
Department of Radiology, Baotou Central Hospital, Baotou 014040, China.
Chin Med Sci J. 2013 Jan;27(4):213-9. doi: 10.1016/s1001-9294(13)60004-8.
Objective To prospectively investigate the diagnostic accuracy for coronary artery stenosis of prospectively electrocardiogram-triggered spiral acquisition mode (high pitch mode) dual-source computed tomography coronary angiography (CTCA) in patients with relatively higher heart rates (HR) compared with catheter coronary angiography (CCA). Methods Forty-seven consecutive patients with relatively higher HR (>65 and <100 bpm) (20 male, 27 female; age 55±10 years) who both underwent dual-source CTCA and CCA were prospectively included in this study. All patients were performed CTCA using high pitch mode setting at 20%-30% of the R-R interval for the image acquisition. All coronary segments were evaluated by two blinded and independent observers with regard to image quality on a three-point scale (1: excellent to 3: non-diagnostic) and for the presence of significant coronary stenoses (defined as diameter narrowing exceeding 50%). Considered CCA as the standard of reference, the sensitivity, specificity, positive predictive value and negative predictive value were calculated. Radiation dose values were calculated using the dose-length product. Results Image quality was rated as being score 1 in 92.4% of segments, score 2 in 6.1% of segmentsand score 3 in 1.5% of segments. The average image quality score per segment was 1.064±0.306. The HR variability of patients with image score 1, 2 and 3 were 2.29±1.06 bpm, 5.17±1.37 bpm, 8.88±1.53 bpm, respectively. The average HR variability of patients with different image scores were significantly different (F=170.402, P=0.001). The sensitivity, specificity, positive and negative predictive values were 92.6%, 97.0%, 87.6%, 98.3%, respectively, per segment and 90.0%, 95.2%, 85.3%, 96.9%, respectively, per vessel and 100%, 63.6%, 90.0%, 100%, respectively, per patient. The effective radiation dose was on average 0.86±0.16 mSv. Conclusion In patients with HR more than 65 bpm and below 100 bpm without cardiac arrhythmia, the prospectively electrocardiogram-gated high-pitch spiral acquisition mode with image acquired timing set at 20%-30% of the R-R interval provides a high diagnostic accuracy for the assessment of coronary stenoses combined with a 1.5% of non-diagnostic coronary segments and a radiation dose below 1 mSv.
目的 前瞻性研究前瞻性心电图触发螺旋采集模式（高螺距模式）双源计算机断层扫描冠状动脉造影（CTCA）对心率相对较高（HR）患者冠状动脉狭窄的诊断准确性，并与导管冠状动脉造影（CCA）进行比较。方法 本研究前瞻性纳入47例HR相对较高（>65且<100次/分钟）的连续患者（男性20例，女性27例；年龄55±10岁），这些患者均接受了双源CTCA和CCA检查。所有患者均采用高螺距模式进行CTCA检查，图像采集时间设置为R-R间期的20%-30%。两名盲法且独立的观察者对所有冠状动脉节段的图像质量进行三点量表评分（1：优秀至3：非诊断性），并评估是否存在显著冠状动脉狭窄（定义为直径狭窄超过50%）。以CCA作为参考标准，计算敏感性、特异性、阳性预测值和阴性预测值。使用剂量长度乘积计算辐射剂量值。结果 92.4%的节段图像质量评分为1分，6.1%的节段评分为2分，1.5%的节段评分为3分。每个节段的平均图像质量评分为1.064±0.306。图像评分为1分、2分和3分的患者的HR变异性分别为2.29±1.06次/分钟、5.17±1.37次/分钟、8.88±1.53次/分钟。不同图像评分患者的平均HR变异性有显著差异（F=170.402，P=0.001）。每个节段的敏感性、特异性、阳性和阴性预测值分别为92.6%、97.0%、87.6%、98.3%，每个血管分别为90.0%、95.2%、85.3%、96.9%，每个患者分别为100%、63.6%、90.0%、100%。有效辐射剂量平均为0.86±0.16 mSv。结论 在无心律失常且HR大于65次/分钟且低于100次/分钟的患者中，前瞻性心电图门控高螺距螺旋采集模式，图像采集时间设置为R-R间期的20%-30%，对冠状动脉狭窄的评估具有较高的诊断准确性，非诊断性冠状动脉节段比例为1.5%，辐射剂量低于1 mSv。
