Urabe Yoji, Yamamoto Hideya, Kitagawa Toshiro, Utsunomiya Hiroto, Tsushima Hiroshi, Tatsugami Fuminari, Awai Kazuo, Kihara Yasuki
Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences.
J Atheroscler Thromb. 2016 Dec 1;23(12):1324-1333. doi: 10.5551/jat.35808. Epub 2016 Jul 9.
In a new-generation computed tomography (CT) scanner, coronary artery calcium (CAC) scores were measured using 3.0-mm slice reconstruction images originally acquired with 0.5 mm thickness scans in a single beat. This study investigated the usefulness of thin-slice (0.5 mm) reconstruction for identifying small calcifications in coronary arteries and evaluated the association with coronary plaques and stenosis compared to conventional 3.0-mm reconstruction images.
We evaluated 132 patients with zero CAC scores in conventional 3.0-mm Agatston method using a 320-slice CT. Then, 0.5-mm slice reconstruction was performed to identify small calcifications. The presence of stenosis and coronary plaques was assessed using coronary CT angiography.
In total, 22 small calcifications were identified in 18 patients. There were 28 (21%) patients with any (≥ 25%) stenosis (34 lesions). Forty-seven coronary plaques were found in 33 patients (25%), including 7 calcified plaques in 7 patients (5%), 34 noncalcified plaques in 27 patients (20%), and 6 partially calcified plaques in 5 patients (4%). Patients with small calcifications had a significantly higher prevalence of noncalcified or partially calcified plaques (83% vs 14%; p＜0.001) and obstructive stenosis (33% vs 5.2%; p＜0.001) compared to those without small calcifications. The addition of small calcifications to the coronary risk factors when diagnosing stenosis significantly improved the diagnostic value.
Small calcifications detected by thin-slice 0.5-mm reconstruction are useful for distinguishing coronary atherosclerotic lesions in patients with zero CAC scores from conventional CT reconstruction.
在新一代计算机断层扫描（CT）扫描仪中，使用最初在单心动周期内以0.5毫米厚度扫描采集的3.0毫米层厚重建图像测量冠状动脉钙化（CAC）积分。本研究调查了薄层（0.5毫米）重建在识别冠状动脉小钙化方面的实用性，并与传统的3.0毫米重建图像相比，评估其与冠状动脉斑块和狭窄的相关性。
我们使用320层CT对132例采用传统3.0毫米阿加特斯顿法测量CAC积分为零的患者进行评估。然后进行0.5毫米层厚重建以识别小钙化。使用冠状动脉CT血管造影评估狭窄和冠状动脉斑块的存在情况。
总共在18例患者中识别出22处小钙化。有28例（21%）患者存在任何（≥25%）狭窄（34处病变）。在33例患者（25%）中发现47个冠状动脉斑块，包括7例患者（5%）中的7个钙化斑块、27例患者（20%）中的34个非钙化斑块以及5例患者（4%）中的6个部分钙化斑块。与没有小钙化的患者相比，有小钙化的患者非钙化或部分钙化斑块的患病率（83%对14%；p＜0.001）和阻塞性狭窄的患病率（33%对5.2%；p＜0.001）显著更高。在诊断狭窄时将小钙化添加到冠状动脉危险因素中可显著提高诊断价值。
通过0.5毫米薄层重建检测到的小钙化有助于将CAC积分为零的患者中的冠状动脉粥样硬化病变与传统CT重建区分开来。
