Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea; Cardiovascular Imaging Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
Clin Radiol. 2013 Dec;68(12):e659-68. doi: 10.1016/j.crad.2013.07.015. Epub 2013 Sep 10.
To assess the additional value of adenosine-stress dynamic computed tomography (CT) perfusion (ASDCTP) imaging compared with coronary CT angiography (CCTA) alone to detect significant coronary artery stenosis for each threshold of 50% and 70% diameter stenosis.
The study included 34 patients (65 ± 11 years, 79% men) with suspected coronary artery diseases who underwent ASDCTP imaging using a 128-section dual-source CT (DSCT) and invasive coronary angiography (ICA). Two investigators classified coronary artery stenosis on CCTA as severe or not. If appropriate image quality could not be acquired due to artefacts, the segment was classified as a lesion with significant stenosis. After the interpretation of ASDCTP imaging, the degree of stenosis was reclassified. All parameters of diagnostic accuracy were calculated before and after ASDCTP analysis for detection of significant coronary artery stenosis with ICA as the reference standard.
The diagnostic accuracy parameters per vessel for the detection of ≥50% stenosis before and after ASDCTP analysis changed as follows: sensitivity, from 80% to 83%; specificity, from 83% to 98%; positive predictive value (PPV), from 87% to 98%; and negative predictive value (NPV), from 75% to 80%. The addition of ASDCTP resulted in reclassification from one class of stenosis severity to another in a significant number of vessels with threshold of 50% stenosis [net reclassification improvement (NRI), 0.176; p < 0.01]. Conversely, the addition of ASDCTP did not result in significant reclassification of stenosis severity in vessels with threshold of 70% stenosis (NRI, 0.034; p = 0.51).
ASDCTP imaging provides incremental value in the detection of significant coronary artery stenosis using a threshold of 50%.
评估腺苷负荷动态 CT 灌注（ASDCTP）成像与单纯冠状动脉 CT 血管造影（CCTA）相比，在检测 50%和 70%直径狭窄程度的显著冠状动脉狭窄方面的附加价值。
本研究纳入 34 例疑似冠心病患者（65±11 岁，79%为男性），采用 128 层双源 CT（DSCT）进行 ASDCTP 成像，并进行有创冠状动脉造影（ICA）。两名研究者根据 CCTA 将冠状动脉狭窄程度分为严重或不严重。如果由于伪影而无法获得适当的图像质量，则将节段归类为有显著狭窄病变。在 ASDCTP 成像解释后，重新分类狭窄程度。在进行 ASDCTP 分析前后，根据 ICA 作为参考标准，计算出所有诊断准确性参数，以检测出有显著冠状动脉狭窄。
ASDCTP 分析前后，每支血管检测≥50%狭窄的诊断准确性参数变化如下：敏感性从 80%提高到 83%；特异性从 83%提高到 98%；阳性预测值（PPV）从 87%提高到 98%；阴性预测值（NPV）从 75%提高到 80%。在狭窄程度为 50%的阈值下，ASDCTP 的加入导致大量血管从一个狭窄程度类别重新分类到另一个类别（净重新分类改善，NRI，0.176；p<0.01）。相反，在狭窄程度为 70%的阈值下，ASDCTP 的加入并未导致显著的狭窄程度重新分类（NRI，0.034；p=0.51）。
ASDCTP 成像在检测 50%的显著冠状动脉狭窄方面提供了附加价值。
