Departement of Internal Medicine, Yeungnam University College of Medicine, Daegu, Korea.
Diabetes Metab J. 2013 Feb;37(1):54-62. doi: 10.4093/dmj.2013.37.1.54. Epub 2013 Feb 15.
A 64-slice multidetector computed tomography (MDCT) is well known to be a useful noninvasive form of angiography for the general population, but not for certain patients with diabetes. The aim of this study was to investigate the diagnostic accuracy and usefulness of 64-slice MDCT coronary angiography for detecting coronary artery disease in Korean patients with type 2 diabetes mellitus (T2DM).
A total of 240 patients were included, 74 of whom had type 2 diabetes (M:F=40:33; 41.8±9.5 years). We compared significant coronary stenosis (>50% luminal narrowing) in MDCT with invasive coronary angiography (ICA) by segment, artery, and patient. We also evaluated the influence of obesity and coronary calcium score on MDCT accuracy.
Of the 4,064 coronary segments studied, 4,062 segments (T2DM=1,109) were assessed quantitatively by both MDCT and ICA, and 706 segments (T2DM=226) were detected as a significant lesion by ICA in all patients. Sensitivity, specificity, as well as positive and negative predictive values for the presence of significant stenosis in T2DM were: by segment, 89.4%, 96.4%, 85.8%, and 97.4%, respectively; by artery (n=222), 95.1%, 92.9%, 94.4%, and 93.8%, respectively; by patients (n=74), 98.4%, 100.0%, 98.4%, and 90.0%, respectively. Regardless of presence of diabetes, there was no significant difference in diagnostic accuracy. Obesity (≥25 kg/m(2)) and coronary calcium score did not also affect the diagnostic accuracy of MDCT.
The 64-slice MDCT coronary angiography was found to have similar diagnostic accuracy with ICA, regardless of diabetes. These results suggest MDCT may be helpful to reduce unnecessary invasive studies for patients with diabetes.
64 层多排螺旋 CT（MDCT）是一种众所周知的、用于普通人群的非侵入性血管造影方法，但对于某些糖尿病患者则不适用。本研究旨在探讨 64 层 MDCT 冠状动脉造影在韩国 2 型糖尿病（T2DM）患者中检测冠状动脉疾病的诊断准确性和实用性。
共纳入 240 例患者，其中 74 例患有 2 型糖尿病（男：女=40：33；41.8±9.5 岁）。我们通过节段、动脉和患者比较了 MDCT 与有创冠状动脉造影（ICA）在检测冠状动脉狭窄（管腔狭窄>50%）方面的差异。我们还评估了肥胖和冠状动脉钙评分对 MDCT 准确性的影响。
在研究的 4064 个冠状动脉节段中，4062 个节段（T2DM=1109 个）通过 MDCT 和 ICA 进行了定量评估，在所有患者中，706 个节段（T2DM=226 个）通过 ICA 检测为显著病变。T2DM 患者中存在显著狭窄的节段、动脉和患者的敏感性、特异性以及阳性和阴性预测值分别为：节段水平，89.4%、96.4%、85.8%和 97.4%；动脉水平（n=222），95.1%、92.9%、94.4%和 93.8%；患者水平（n=74），98.4%、100.0%、98.4%和 90.0%。无论是否患有糖尿病，MDCT 的诊断准确性均无显著差异。肥胖（≥25kg/m2）和冠状动脉钙评分也不会影响 MDCT 的诊断准确性。
64 层 MDCT 冠状动脉造影与 ICA 具有相似的诊断准确性，无论是否患有糖尿病。这些结果表明 MDCT 可能有助于减少糖尿病患者不必要的有创检查。
