Sun Zhonghua, Xu Lei, Fan Zhanming
Department of Medical Radiation Sciences, Curtin University, Perth, WA 6845, Australia.
Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China.
Int J Cardiol. 2016 Jan 15;203:78-86. doi: 10.1016/j.ijcard.2015.10.079. Epub 2015 Oct 20.
To investigate the diagnostic value of coronary CT angiography (CCTA) by bifurcation angle measurement in the assessment of calcified plaques compared to conventional coronary lumen analysis.
Fifty-three patients with calcified plaques identified on CCTA in the left coronary artery were included in the study. Minimal lumen diameter (MLD) and bifurcation angle between the left anterior descending (LAD) and left circumflex (LCx) arteries were measured and compared between CCTA and invasive coronary angiography (ICA), while the areas under the curves (AUCs) by receiver-operating characteristic curve analysis (ROC) were compared between CCTA and ICA with regard to the diagnostic value of using bifurcation angle as a criterion.
On a per-vessel assessment, the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) and 95% confidence interval (CI) with the use of bifurcation angle for determining coronary stenosis were 100% (86%, 100%), 79% (59%, 92%), 81% (62%, 92%), and 100% (85%, 100%) for CCTA, and 100% (86%, 100%), 82% (63%, 94%), 83% (65%, 94%), and 100% (85%, 100%) for ICA, respectively. While the sensitivity and NPV remained unchanged, the specificity and PPV of CCTA by MLD were 33% (21%, 47%) and 43% (31%, 56%). The AUCs by ROC curve analysis for CCTA and ICA bifurcation angle measurements demonstrated no significant difference (p>0.05, 0.79 vs 0.86, and 0.70 vs 0.68 at the LAD and LCx assessment, respectively).
Coronary CT angiography by bifurcation angle measurement shows significant improvement in the diagnosis of calcified plaques with diagnostic value comparable to invasive coronary angiography.
与传统冠状动脉管腔分析相比，研究通过测量分叉角度的冠状动脉CT血管造影（CCTA）在评估钙化斑块中的诊断价值。
本研究纳入了53例在CCTA上发现左冠状动脉有钙化斑块的患者。测量并比较CCTA与有创冠状动脉造影（ICA）之间左前降支（LAD）和左旋支（LCx）动脉的最小管腔直径（MLD）和分叉角度，同时通过受试者操作特征曲线分析（ROC）比较CCTA和ICA在以分叉角度为标准的诊断价值方面的曲线下面积（AUC）。
在每支血管评估中，使用分叉角度确定冠状动脉狭窄时，CCTA的敏感性、特异性、阳性预测值（PPV）和阴性预测值（NPV）及95%置信区间（CI）分别为100%（86%，100%）、79%（59%，92%）、81%（62%，92%）和100%（85%，100%），ICA分别为100%（86%，100%）、82%（63%，94%）、83%（65%，94%）和100%（85%，100%）。虽然敏感性和NPV保持不变，但CCTA通过MLD得出的特异性和PPV分别为33%（21%，47%）和43%（31%，56%）。ROC曲线分析得出的CCTA和ICA分叉角度测量的AUC无显著差异（p>0.05，在LAD和LCx评估时分别为0.79对0.86以及0.70对0.68）。
通过测量分叉角度的冠状动脉CT血管造影在钙化斑块诊断方面显示出显著改善，其诊断价值与有创冠状动脉造影相当。
