Mahdavi Arash, Mohammadzadeh Ali, Joodi Golsa, Tabatabaei Mohammad Reza, Sheikholeslami Farhad, Motevalli Marzieh
Faculty of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran.
Iran J Radiol. 2016 Feb 29;13(2):e24350. doi: 10.5812/iranjradiol.24350. eCollection 2016 Apr.
There are numerous studies that address the diagnostic value of dual-source computed tomography (DSCT) as an alternative to conventional coronary angiography (CCA). However, the benefit of application of DSCT in a real world clinical setting should be evaluated.
To determine the diagnostic accuracy of DSCT technique compared with CCA as the gold standard method in detection of coronary artery stenosis among symptomatic patients who are presented to a referral cardiovascular center during daily clinical practice.
Evaluating the medical records of a tertiary care referral cardiovascular center, 47 patients who had undergone DSCT and CCA, and also met the inclusion and exclusion criteria of the study were selected. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and likelihood ratios (LRs) of the DSCT imaging technique were calculated.
In total, 97.8% of the segments (628/642) could be visualized with diagnostic image quality via DSCT coronary angiography. The mean heart rate during DSCT was 69.2 ± 12.2 bpm (range: 39 - 83 bpm), and the mean Agatston score was 507.7 ± 590.5 (range: 0 - 2328). Per segment analysis of the findings revealed that the sensitivity, specificity, PPV, NPV, positive LR (PLR) and negative LR (NLR) of DSCT technique for evaluation of patients with coronary artery disease were 93.7%, 96.8%, 92.7%, 97.2%, 29.4, and 0.066, respectively. Also per vessel, analysis of the findings showed a sensitivity of 97.1%, a specificity of 94.0%, PPV of 95.3%, NPV of 96.3%, PLR of 16.1, and NLR of 0.030.
Our results indicate that DSCT coronary angiography provides high diagnostic accuracy for the evaluation of CAD patients during daily routine practice of a referral cardiovascular setting.
有大量研究探讨了双源计算机断层扫描（DSCT）作为传统冠状动脉造影（CCA）替代方法的诊断价值。然而，应评估DSCT在实际临床环境中的应用效益。
在日常临床实践中，将DSCT技术与作为金标准方法的CCA进行比较，以确定DSCT技术在有症状患者冠状动脉狭窄检测中的诊断准确性，这些患者被转诊至心血管中心。
评估一家三级医疗转诊心血管中心的病历，选择47例接受了DSCT和CCA检查且符合研究纳入和排除标准的患者。计算DSCT成像技术的敏感性、特异性、阳性预测值（PPV）、阴性预测值（NPV）和似然比（LRs）。
通过DSCT冠状动脉造影，总共97.8%的节段（628/642）能够以诊断图像质量进行可视化。DSCT检查期间的平均心率为69.2±12.2次/分钟（范围：39 - 83次/分钟），平均阿加斯顿评分507.7±590.5（范围：0 - 2328）。对研究结果的节段分析显示，DSCT技术评估冠心病患者的敏感性、特异性、PPV、NPV、阳性似然比（PLR）和阴性似然比（NLR）分别为93.7%、96.8%、92.7%、97.2%、29.4和0.066。同样，按血管分析结果显示，敏感性为97.1%，特异性为94.0%，PPV为95.3%，NPV为96.3%，PLR为16.1，NLR为0.030。
我们的结果表明，在转诊心血管中心的日常常规实践中，DSCT冠状动脉造影对冠心病患者的评估具有较高的诊断准确性。
