Falcão João L A A, Falcão Breno A A, Gurudevan Swaminatha V, Campos Carlos M, Silva Expedito R, Kalil-Filho Roberto, Rochitte Carlos E, Shiozaki Afonso A, Coelho-Filho Otavio R, Lemos Pedro A
Heart Institute, Medical School, University of São Paulo Medical School, São Paulo, SP, Brazil.
Cedars-Sinai Heart Institute, Los Angeles, California, United States.
Arq Bras Cardiol. 2015 Apr;104(4):315-23. doi: 10.5935/abc.20140211. Epub 2015 Jan 27.
The diagnostic accuracy of 64-slice MDCT in comparison with IVUS has been poorly described and is mainly restricted to reports analyzing segments with documented atherosclerotic plaques.
We compared 64-slice multidetector computed tomography (MDCT) with gray scale intravascular ultrasound (IVUS) for the evaluation of coronary lumen dimensions in the context of a comprehensive analysis, including segments with absent or mild disease.
The 64-slice MDCT was performed within 72 h before the IVUS imaging, which was obtained for at least one coronary, regardless of the presence of luminal stenosis at angiography. A total of 21 patients were included, with 70 imaged vessels (total length 114.6 ± 38.3 mm per patient). A coronary plaque was diagnosed in segments with plaque burden > 40%.
At patient, vessel, and segment levels, average lumen area, minimal lumen area, and minimal lumen diameter were highly correlated between IVUS and 64-slice MDCT (p < 0.01). However, 64-slice MDCT tended to underestimate the lumen size with a relatively wide dispersion of the differences. The comparison between 64-slice MDCT and IVUS lumen measurements was not substantially affected by the presence or absence of an underlying plaque. In addition, 64-slice MDCT showed good global accuracy for the detection of IVUS parameters associated with flow-limiting lesions.
In a comprehensive, multi-territory, and whole-artery analysis, the assessment of coronary lumen by 64-slice MDCT compared with coronary IVUS showed a good overall diagnostic ability, regardless of the presence or absence of underlying atherosclerotic plaques.
与血管内超声（IVUS）相比，64层螺旋CT（MDCT）的诊断准确性描述较少，主要限于分析有动脉粥样硬化斑块记录节段的报告。
我们在包括无病变或轻度病变节段的综合分析背景下，比较64层螺旋CT（MDCT）与灰阶血管内超声（IVUS）评估冠状动脉管腔尺寸。
在IVUS成像前72小时内进行64层MDCT检查，无论血管造影时管腔狭窄情况如何，至少对一根冠状动脉进行IVUS成像。共纳入21例患者，70根血管成像（每位患者血管总长度114.6±38.3mm）。斑块负荷>40%的节段诊断为冠状动脉斑块。
在患者、血管和节段水平上，IVUS与64层MDCT之间的平均管腔面积、最小管腔面积和最小管腔直径高度相关（p<0.01）。然而，64层MDCT倾向于低估管腔大小，差异相对分散。64层MDCT与IVUS管腔测量值的比较不受潜在斑块存在与否的实质性影响。此外，64层MDCT在检测与血流限制性病变相关的IVUS参数方面显示出良好的整体准确性。
在全面、多区域和全动脉分析中，与冠状动脉IVUS相比，64层MDCT评估冠状动脉管腔显示出良好的总体诊断能力，无论是否存在潜在动脉粥样硬化斑块。
