Engel Leif-Christopher, Thai Wai-Ee, Medina-Zuluaga Hector, Karolyi Mihaly, Sidhu Manavjot S, Maurovich-Horvat Pal, Margey Ronan, Pomerantsev Eugene, Abbara Suhny, Ghoshhajra Brian B, Hoffmann Udo, Liew Gary Y
Cardiac MR PET CT Program, Department of Radiology and Division of Cardiology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA.
Acta Radiol. 2017 May;58(5):528-536. doi: 10.1177/0284185116663041. Epub 2016 Sep 30.
Background Heavy coronary artery calcification (CAC) impairs diagnostic accuracy of coronary computed tomography angiography (cCTA) and is considered to be a major limitation. Purpose To investigate the effect of non-evaluable CAC seen on cCTA on clinical decision-making by determining the degree of subsequent invasive testing and to assess the relationship between non-evaluable segments containing CAC and significant stenosis as seen in invasive coronary angiography (ICA). Material and Methods The study comprised of 356 patients who underwent cCTA and subsequent ICA within 2 months between 2005 and 2009. Clinical reports were reviewed to identify the indications for referral to ICA. In a subset of 68 patients where non-diagnostic CAC on cCTA and significant stenosis on ICA were present in the same segment, we correlated and analyzed the underlying stenosis severity of the lesion on ICA to the cCTA. Lesions with CAC were analyzed in a standardized fashion by application of reading rules. Results Non-diagnostic CAC on cCTA prompted ICA in 5.6% of patients. CAC occurred at the site of maximum stenosis in segments with stenosis <50% (95.9% [47/49]), 50-69% (82.4% [28/34]), 70-99% (64.5% [31/48]), and 100% (33.3% [1/3]). At the point of maximum calcium deposit, non-obstructive disease was present in 61.2%. Application of reading rules resulted in a 44% reduction in non-diagnostic cCTA reads. Conclusion Severe CAC may prompt further investigation with ICA. There is less CAC with increasing lesion severity at the point of maximum stenosis. Additional application of reading rules improved non-diagnostic cCTA reads.
背景 严重冠状动脉钙化（CAC）会降低冠状动脉计算机断层扫描血管造影（cCTA）的诊断准确性，被视为主要限制因素。目的 通过确定后续侵入性检查的程度，研究cCTA上不可评估的CAC对临床决策的影响，并评估侵入性冠状动脉造影（ICA）中含CAC的不可评估节段与严重狭窄之间的关系。材料与方法 本研究纳入了2005年至2009年间在2个月内接受cCTA及后续ICA检查的356例患者。回顾临床报告以确定转诊至ICA的指征。在68例cCTA上存在非诊断性CAC且ICA上存在严重狭窄的同一节段的患者亚组中，我们将ICA上病变的潜在狭窄严重程度与cCTA进行了关联和分析。对有CAC的病变采用阅读规则进行标准化分析。结果 cCTA上的非诊断性CAC促使5.6%的患者进行了ICA检查。CAC出现在狭窄<50%（95.9%[47/49]）、50 - 69%（82.4%[28/34]）、70 - 99%（64.5%[31/48]）和100%（33.3%[1/3]）节段的最大狭窄部位。在最大钙沉积点，存在非阻塞性疾病的比例为61.2%。应用阅读规则使非诊断性cCTA读数减少了44%。结论 严重CAC可能促使进一步行ICA检查。在最大狭窄点，随着病变严重程度增加，CAC较少。阅读规则的额外应用改善了非诊断性cCTA读数。
