钙化冠状动脉斑块的虚拟血管内内窥镜可视化：一种识别斑块特征以更准确评估冠状动脉管腔狭窄的新方法。

Virtual intravascular endoscopy visualization of calcified coronary plaques: a novel approach of identifying plaque features for more accurate assessment of coronary lumen stenosis.

作者信息

Xu Lei, Sun Zhonghua

机构信息

From the Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China (LX); and Discipline of Medical Radiation Sciences, School of Science, Curtin University, Perth, Western Australia, Australia (ZS).

出版信息

Medicine (Baltimore). 2015 May;94(17):e805. doi: 10.1097/MD.0000000000000805.

This study was conducted to investigate the feasibility of using 3D virtual intravascular endoscopy (VIE) as a novel approach for characterization of calcified coronary plaques with the aim of differentiating superficial from deep calcified plaques, thus improving assessment of coronary stenosis.A total of 61 patients with suspected coronary artery disease were included in the study. Minimal lumen diameter (MLD) was measured and compared between coronary CT angiography (CCTA) (≥64-slice) and invasive coronary angiography (ICA) with regard to the measurement bias, whereas VIE findings were correlated with CCTA with respect to the diagnostic performance of coronary stenosis and the area under the curve (AUC) by receiver-operating characteristic curve analysis (ROC).In all 3 coronary arteries, the CCTA consistently underestimated the MLD relative to the ICA (P < 0.001). On a per-vessel assessment, the sensitivity, specificity, positive predictive value, and negative predictive value and 95% confidence interval (CI) were 94% (95% CI: 61%, 100%), 27% (95% CI: 18%, 38%), 33% (95% CI: 23%, 43%), and 92% (95% CI: 74%, 99%) for CCTA, and 100% (95% CI: 89%, 100%), 85% (95% CI: 75%, 92%), 71% (95% CI: 56%, 84%), and 100% (95% CI: 95%, 100%) for VIE, respectively. The AUC by ROC analysis for VIE demonstrated significant improvement in analysis of left anterior descending calcified plaques compared with CCTA (0.99 vs 0.60, P < 0.001), with better performance in the left circumflex and right coronary arteries (0.98 vs 0.84 and 0.77 vs 0.77, respectively; P = 0.07 and P = 0.96, respectively). There are no significant differences between 64-, 128-, and 640-slice CCTA and VIE in terms of sensitivity, specificity, positive and negative predictive value in the diagnosis of coronary stenosis.This study shows the feasibility of using VIE for characterizing morphological features of calcified plaques, therefore, significantly improving assessment of coronary stenosis.

本研究旨在探讨使用三维虚拟血管内内窥镜检查（VIE）作为一种新型方法来表征钙化冠状动脉斑块的可行性，目的是区分浅表钙化斑块和深部钙化斑块，从而改善对冠状动脉狭窄的评估。共有61例疑似冠心病患者纳入本研究。测量了冠状动脉CT血管造影（CCTA，≥64层）和有创冠状动脉造影（ICA）之间的最小管腔直径（MLD），并比较了测量偏差，同时通过接受者操作特征曲线分析（ROC）将VIE检查结果与CCTA在冠状动脉狭窄的诊断性能和曲线下面积（AUC）方面进行了相关性分析。在所有3支冠状动脉中，CCTA相对于ICA持续低估了MLD（P<0.001）。在单支血管评估中，CCTA的敏感性、特异性、阳性预测值、阴性预测值及95%置信区间（CI）分别为94%（95%CI：61%，100%）、27%（95%CI：18%，38%）、33%（95%CI：23%，43%）和92%（95%CI：74%，99%），VIE的分别为100%（95%CI：89%，100%）、85%（95%CI：75%，92%）、71%（95%CI：56%，84%）和100%（95%CI：95%，100%）。通过ROC分析，VIE的AUC显示，与CCTA相比，在分析左前降支钙化斑块方面有显著改善（0.99对0.60，P<0.001），在左旋支和右冠状动脉中表现更好（分别为0.98对0.84和0.77对0.77；P分别为0.07和0.96）。在冠状动脉狭窄诊断的敏感性、特异性、阳性和阴性预测值方面，64层、128层和640层CCTA与VIE之间无显著差异。本研究表明使用VIE表征钙化斑块形态特征的可行性，因此，可显著改善对冠状动脉狭窄的评估。