Yoshioka Kunihiro, Tanaka Ryoichi, Takagi Hidenobu, Nagata Kyouhei, Chiba Takuya, Takeda Kouta, Ueda Takanori, Sugawara Tsuyoshi, Sasaki Akinobu, Ueyama Yuta, Kikuchi Kei, Sasaki Tadashi
1 Division of Cardiovascular Radiology, Department of Radiology, Iwate Medical University, Morioka, Japan.
2 Division of Cardiology, Department of Internal Medicine, Iwate Medical University, Morioka, Japan.
Br J Radiol. 2016 Oct;89(1066):20160489. doi: 10.1259/bjr.20160489. Epub 2016 Aug 15.
To explore the feasibility and diagnostic accuracy of modified subtraction coronary CT angiography (CCTA) with short breath-holding time in patients who have limited breath-hold capability and severe coronary artery calcification.
11 patients with a coronary calcium score >400 underwent CCTA using a modified subtraction protocol. All patients were unable to hold their breath for more than 20 s. Subjective image quality using a four-point scale and the presence of significant (>50%) luminal stenosis were assessed for each calcified or stented segment on both conventional CCTA and modified subtraction CCTA images and compared with invasive coronary angiography (ICA) as the gold standard.
The mean breath-holding time was 13.0 ± 0.9 s. A total of 35 calcified or stented coronary segments were evaluated. The average image quality was increased from 2.1 ± 0.9 with conventional CCTA to 3.1 ± 0.7 with subtraction CCTA (p < 0.001). The segment-based diagnostic accuracy for detecting significant stenosis according to ICA revealed an area under the receiver-operating characteristic curve of 0.722 for conventional CCTA and 0.892 for subtraction CCTA (p = 0.036).
Modified subtraction CCTA allows the breath-holding time to be shortened to <15 s. As compared with conventional CCTA, modified subtraction CCTA showed improvement in image quality and diagnostic accuracy in patients with limited breath-hold capability and severe calcification.
Modified subtraction CCTA can improve the diagnostic accuracy in patients with a high calcium score and patients who are unable to perform long breath-holds.
探讨在屏气能力受限且冠状动脉严重钙化的患者中，采用短屏气时间的改良减法冠状动脉CT血管造影（CCTA）的可行性及诊断准确性。
11例冠状动脉钙化积分>400的患者采用改良减法方案行CCTA检查。所有患者屏气时间均不能超过20秒。在传统CCTA图像和改良减法CCTA图像上，采用四点量表评估每个钙化或支架置入节段的主观图像质量，并评估是否存在显著（>50%）的管腔狭窄，以有创冠状动脉造影（ICA）作为金标准进行比较。
平均屏气时间为13.0±0.9秒。共评估了35个钙化或支架置入的冠状动脉节段。平均图像质量从传统CCTA的2.1±0.9提高到减法CCTA的3.1±0.7（p<0.001）。根据ICA检测显著狭窄的基于节段的诊断准确性显示，传统CCTA的受试者操作特征曲线下面积为0.722，减法CCTA为0.892（p=0.036）。
改良减法CCTA可将屏气时间缩短至<15秒。与传统CCTA相比，改良减法CCTA在屏气能力受限和严重钙化的患者中图像质量和诊断准确性有所提高。
改良减法CCTA可提高钙化积分高及无法长时间屏气患者的诊断准确性。
