Department of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim-Heidelberg University, Theodor-Kutzer-Ufer 1-3, D-68167 Mannheim, Germany.
Acad Radiol. 2013 Aug;20(8):980-6. doi: 10.1016/j.acra.2013.02.014. Epub 2013 Jun 2.
Given the significance of coronary artery disease as the most important socioeconomic health care problem in the Western World, the application of computer-aided simple triage (CAST) systems to this disease would be desirable.
In total, 93 patients with acute chest pain and an intermediate risk score for acute coronary syndrome underwent coronary computed tomography angiography (cCTA). Among those, 74 were of adequate image quality for automated analysis by a commercially available CAST system (COR Analyzer, RCADIA, Haifa, Israel). CAST findings were compared to human expert interpretation for the detection of significant stenosis (≥50%) in the left main, left anterior descending, circumflex, right coronary artery, or arterial branches. Further, one inexperienced observer evaluated all studies for significant stenoses alone and after 1 month guided by a CAST system as an initial read.
Human expert interpretation identified 37/74 patients with stenosis ≥50%, whereas the CAST detected 45 patients. The CAST system demonstrated a sensitivity of 100%/79% and a specificity of 78%/89% on a per-patient/per-vessel level, respectively. With CAST, the inexperienced readers' per-vessel sensitivity and positive predictive values significantly improved (P = .011, P = .009) from 69% and 41% to 91% and 74%, respectively.
The investigated CAST system for automatic stenosis detection can accurately identify patients with coronary artery stenosis ≥50% and may be of use as initial interpretation and triage of cCTA studies as well as a second reader for inexperienced readers, in absence of expert readers.
鉴于冠状动脉疾病作为西方世界最重要的社会经济学医疗保健问题，应用计算机辅助简单分诊（CAST）系统来诊断该疾病是可取的。
共纳入 93 例急性胸痛且急性冠状动脉综合征风险评分中等的患者进行冠状动脉计算机断层血管造影（cCTA）检查。其中，74 例患者的图像质量足以进行商业化 CAST 系统（COR Analyzer，RCADIA，海法，以色列）的自动分析。将 CAST 结果与人工专家解释进行比较，以检测左主干、左前降支、回旋支、右冠状动脉或动脉分支的显著狭窄（≥50%）。此外，一名无经验观察者单独评估所有研究中是否存在显著狭窄，并在 1 个月后根据 CAST 系统进行初始读片。
人工专家解释识别出 37/74 例患者存在≥50%狭窄，而 CAST 系统检测出 45 例患者。CAST 系统在患者和血管水平上的敏感性分别为 100%/79%和特异性为 78%/89%。使用 CAST 系统，无经验观察者的血管敏感性和阳性预测值分别从 69%和 41%显著提高至 91%和 74%（P=0.011，P=0.009）。
所研究的用于自动狭窄检测的 CAST 系统可以准确识别出≥50%冠状动脉狭窄的患者，可作为 cCTA 研究的初始解释和分诊工具，以及在缺乏专家观察者时作为无经验观察者的第二读片者。
