Istituto di Radiologia, Azienda Ospedaliero Universitaria Integrata di Verona, Policlinico G.B. Rossi, P.le L.A. Scuro 10, 37134, Verona, Italy,
Radiol Med. 2013 Dec;118(8):1281-93. doi: 10.1007/s11547-013-0935-x. Epub 2013 May 27.
Coronary angiography using multidetector computed tomography (MDCT-CA) is a recent technique for the nonivasive study of coronary arteries. This study assessed the diagnostic accuracy of coronary artery stenosis evaluation obtained by three readers at different levels of training or at different points of the learning curve proposed by the international guidelines.
Three radiologists in training with different levels of experience in MDCT-CA scored 50 cases at various time points of the learning curve: baseline, 4 weeks, 8 weeks and 6 months. The trainee radiologists evaluated the degree of stenosis on each coronary segment, and overall accuracy was calculated on a per-segment, pervessel and per-patient basis.
All readers improved analysis accuracy per segment (range, 73-90%); sensitivity reached 45% per segment, 84% per vessel and 93% per patient; specificity was 99% per segment and vessel and 98% per patient. Positive and negative predictive values increased to 94% and 92%, respectively.
Although all readers improved in diagnostic performance with growing experience with MDCT-CA, a longer training period may be necessary to achieve adequate levels of expertise in MDCT-CA to be able to perform as independent readers.
多排螺旋计算机断层扫描冠状动脉造影（MDCT-CA）是一种用于冠状动脉无创研究的新技术。本研究评估了三位不同培训水平或在国际指南提出的学习曲线上不同点的读者对冠状动脉狭窄评估的诊断准确性。
三名在 MDCT-CA 方面具有不同经验水平的放射科住院医师在学习曲线的不同时间点（基线、4 周、8 周和 6 个月）对 50 例病例进行评分。受训放射科医师对每个冠状动脉节段的狭窄程度进行评估，并按节段、血管和患者计算总体准确性。
所有读者对每个节段的分析准确性都有所提高（范围为 73%-90%）；敏感性达到每个节段 45%，每个血管 84%，每个患者 93%；特异性为每个节段和血管 99%，每个患者 98%。阳性和阴性预测值分别增加到 94%和 92%。
尽管所有读者的 MDCT-CA 诊断性能都随着经验的增加而提高，但可能需要更长的培训期才能达到 MDCT-CA 的足够专业水平，从而能够作为独立读者进行操作。
