Symons Rolf, Morris Justin Z, Wu Colin O, Pourmorteza Amir, Ahlman Mark A, Lima João A C, Chen Marcus Y, Mallek Marissa, Sandfort Veit, Bluemke David A
From the Department of Radiology and Imaging Sciences, National Institutes of Health Clinical Center, 10 Center Dr, Bldg 10, Room 1C355, Bethesda, MD 20892 (R.S., J.Z.M., A.P., M.A.A., M.M., V.S., D.A.B.); Office of Biostatistics Research (C.O.W.) and Cardiovascular and Pulmonary Branch (M.Y.C.), National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Md; and Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Md (J.A.C.L.).
Radiology. 2016 Dec;281(3):737-748. doi: 10.1148/radiol.2016161670. Epub 2016 Sep 16.
Purpose To determine reader and computed tomography (CT) scan variability for measurement of coronary plaque volume. Materials and Methods This HIPAA-compliant study followed Standards for Reporting of Diagnostic Accuracy guidelines. Baseline coronary CT angiography was performed in 40 prospectively enrolled subjects (mean age, 67 years ± 6 [standard deviation]) with asymptomatic hyperlipidemia by using a 320-detector row scanner (Aquilion One Vision; Toshiba, Otawara, Japan). Twenty of these subjects underwent coronary CT angiography repeated on a separate day with the same CT scanner (Toshiba, group 1); 20 subjects underwent repeat CT performed with a different CT scanner (Somatom Force; Siemens, Forchheim, Germany [group 2]). Intraclass correlation coefficients (ICCs) and Bland-Altman analysis were used to assess interreader, intrareader, and interstudy reproducibility. Results Baseline and repeat coronary CT angiography scans were acquired within 19 days ± 6. Interreader and intrareader agreement rates were high for total, calcified, and noncalcified plaques for both CT scanners (all ICCs ≥ 0.96) without bias. Scanner variability was ±18.4% (coefficient of variation) with same-vendor follow-up. However, scanner variability increased to ±29.9% with different-vendor follow-up. The sample size to detect a 5% change in noncalcified plaque volume with 90% power and an α error of .05 was 286 subjects for same-CT scanner follow-up and 753 subjects with different-vendor follow-up. Conclusion State-of-the-art coronary CT angiography with same-vendor follow-up has good scan-rescan reproducibility, suggesting a role of coronary CT angiography in monitoring coronary artery plaque response to therapy. Differences between coronary CT angiography vendors resulted in lower scan-rescan reproducibility. RSNA, 2016 Online supplemental material is available for this article.
目的 确定用于测量冠状动脉斑块体积的阅片者及计算机断层扫描（CT）扫描的变异性。材料与方法 本符合健康保险流通与责任法案（HIPAA）的研究遵循诊断准确性报告标准指南。对40例前瞻性纳入的无症状高脂血症受试者（平均年龄67岁±6[标准差]）使用320排探测器CT扫描仪（Aquilion One Vision；东芝，大田原，日本）进行基线冠状动脉CT血管造影。其中20例受试者在另一天使用同一台CT扫描仪重复进行冠状动脉CT血管造影（东芝，第1组）；20例受试者使用不同的CT扫描仪（Somatom Force；西门子，福尔希海姆，德国[第2组]）进行重复CT检查。采用组内相关系数（ICC）和Bland-Altman分析评估阅片者间、阅片者内及研究间的可重复性。结果 基线及重复冠状动脉CT血管造影扫描在19天±6内完成。两台CT扫描仪对于总斑块、钙化斑块及非钙化斑块的阅片者间及阅片者内一致率均较高（所有ICC≥0.96）且无偏差。同一厂家后续检查时扫描仪变异性为±18.4%（变异系数）。然而，不同厂家后续检查时扫描仪变异性增至±29.9%。对于同一台CT扫描仪后续检查，要以90%的检验效能及0.05的α错误检测出非钙化斑块体积5%的变化，所需样本量为286例受试者；对于不同厂家后续检查，则需要753例受试者。结论 采用同一厂家后续检查的先进冠状动脉CT血管造影具有良好的扫描-再扫描可重复性，提示冠状动脉CT血管造影在监测冠状动脉斑块对治疗的反应中具有一定作用。冠状动脉CT血管造影不同厂家之间存在差异，导致扫描-再扫描可重复性降低。RSNA，2016 本文提供在线补充材料。
