计算机断层血管造影和单光子发射计算机断层扫描心肌灌注成像诊断冠状动脉疾病的准确性
Accuracy of Computed Tomographic Angiography and Single-Photon Emission Computed Tomography-Acquired Myocardial Perfusion Imaging for the Diagnosis of Coronary Artery Disease.
作者信息
Arbab-Zadeh Armin, Di Carli Marcelo F, Cerci Rodrigo, George Richard T, Chen Marcus Y, Dewey Marc, Niinuma Hiroyuki, Vavere Andrea L, Betoko Aisha, Plotkin Michail, Cox Christopher, Clouse Melvin E, Arai Andrew E, Rochitte Carlos E, Lima Joao A C, Brinker Jeffrey, Miller Julie M
机构信息
From the Department of Medicine, Division of Cardiology, Johns Hopkins University, Baltimore, MD (A.A.-Z., R.C., R.T.G., A.L.V., J.A.C.L., J.B., J.M.M.); Department of Medicine, Division of Cardiology, Brigham and Women's Hospital, Harvard University, Boston, MA (M.D.C.); Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD (M.Y.C., A.E.A.); Department of Radiology, Charité, Berlin, Germany (M.D., M.P.); Department of Medicine, Division of Cardiology, St. Luke's Hospital, Tokyo, Japan (H.N.); Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD (A.B., C.C.); Department of Radiology, Beth Israel Deaconess MC, Harvard University, Boston, MA (M.E.C.); and Department of Medicine, Division of Cardiology at the Heart Institute (InCor), University of Sao Paulo, Sao Paulo, Brazil (C.E.R.).
出版信息
Circ Cardiovasc Imaging. 2015 Oct;8(10):e003533. doi: 10.1161/CIRCIMAGING.115.003533.
BACKGROUND
Establishing the diagnosis of coronary artery disease (CAD) in symptomatic patients allows appropriately allocating preventative measures. Single-photon emission computed tomography (CT)-acquired myocardial perfusion imaging (SPECT-MPI) is frequently used for the evaluation of CAD, but coronary CT angiography (CTA) has emerged as a valid alternative.
METHODS AND RESULTS
We compared the accuracy of SPECT-MPI and CTA for the diagnosis of CAD in 391 symptomatic patients who were prospectively enrolled in a multicenter study after clinical referral for cardiac catheterization. The area under the receiver operating characteristic curve was used to evaluate the diagnostic accuracy of CTA and SPECT-MPI for identifying patients with CAD defined as the presence of ≥1 coronary artery with ≥50% lumen stenosis by quantitative coronary angiography. Sensitivity to identify patients with CAD was greater for CTA than SPECT-MPI (0.92 versus 0.62, respectively; P<0.001), resulting in greater overall accuracy (area under the receiver operating characteristic curve, 0.91 [95% confidence interval, 0.88-0.94] versus 0.69 [0.64-0.74]; P<0.001). Results were similar in patients without previous history of CAD (area under the receiver operating characteristic curve, 0.92 [0.89-0.96] versus 0.67 [0.61-0.73]; P<0.001) and also for the secondary end points of ≥70% stenosis and multivessel disease, as well as subgroups, except for patients with a calcium score of ≥400 and those with high-risk anatomy in whom the overall accuracy was similar because CTA's superior sensitivity was offset by lower specificity in these settings. Radiation doses were 3.9 mSv for CTA and 9.8 for SPECT-MPI (P<0.001).
CONCLUSIONS
CTA is more accurate than SPECT-MPI for the diagnosis of CAD as defined by conventional angiography and may be underused for this purpose in symptomatic patients.
CLINICAL TRIAL REGISTRATION
URL: http://www.clinicaltrials.gov. Unique identifier: NCT00934037.
背景
对有症状的患者进行冠状动脉疾病（CAD）诊断有助于合理采取预防措施。单光子发射计算机断层扫描（CT）心肌灌注成像（SPECT-MPI）常用于CAD评估，但冠状动脉CT血管造影（CTA）已成为一种有效的替代方法。
方法与结果
我们比较了SPECT-MPI和CTA对391例有症状患者CAD诊断的准确性，这些患者在经临床转诊进行心脏导管检查后被前瞻性纳入一项多中心研究。采用受试者操作特征曲线下面积评估CTA和SPECT-MPI对CAD患者的诊断准确性，CAD定义为定量冠状动脉造影显示至少1支冠状动脉管腔狭窄≥50%。CTA识别CAD患者的敏感性高于SPECT-MPI（分别为0.92和0.62；P<0.001），总体准确性更高（受试者操作特征曲线下面积，0.91[95%置信区间，0.88-0.94]对0.69[0.64-0.74]；P<0.001）。在无CAD既往史的患者中结果相似（受试者操作特征曲线下面积，0.92[0.89-0.96]对0.67[0.61-0.73]；P<0.001），对于≥70%狭窄和多支血管病变的次要终点以及亚组也是如此，但钙评分≥400的患者和具有高危解剖结构的患者除外，在这些患者中总体准确性相似，因为CTA较高的敏感性被较低的特异性所抵消。CTA的辐射剂量为3.9 mSv，SPECT-MPI为9.8 mSv（P<0.001）。
结论
对于传统血管造影定义的CAD诊断，CTA比SPECT-MPI更准确，在有症状的患者中该方法可能未得到充分利用。
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