Kesarwani Manoj, Nakanishi Rine, Choi Tae-Young, Shavelle David M, Budoff Matthew J
Division of Cardiology, University of Washington School of Medicine, Seattle, Washington.
Division of Cardiology, Los Angeles Biomedical Research Center, Harbor-UCLA Medical Center, 1124 W Carson St, Torrance, CA 90502.
Acad Radiol. 2017 Aug;24(8):968-974. doi: 10.1016/j.acra.2017.03.001. Epub 2017 Mar 27.
Although intravascular ultrasound (IVUS) is the current gold standard for plaque characterization, noninvasive coronary computed tomographic angiography (CCTA) requires further evaluation. The ability to detect plaque morphology by CCTA remains unclear. The purpose of this study was to evaluate the diagnostic accuracy of CCTA for plaque detection and morphology.
Thirty-one patients underwent cardiac catheterization with IVUS and CCTA. The presence of plaque was evaluated by both modalities in nonocclusive segments (<50% stenosis) of the left anterior descending artery, left circumflex artery, and right coronary artery. Plaque morphology was classified as (1) normal, (2) soft or fibrous, (3) fibrocalcific, or (4) calcific. Results by IVUS and CCTA were compared blindly on a segment-to-segment basis with subgroup analysis based on CCTA tube voltage.
Among the 31 patients (mean age 56.2 ± 8.6 years, 27% female), 152 segments were analyzed. Of these segments, 42% were in the left anterior descending artery, 32% were in the left circumflex artery, and 26% were in the right coronary artery. Plaque morphology by IVUS identified 103 segments as fibrous (68%), 31 as fibrocalcific (20%), and 6 as calcific (4.0%); 12 segments were normal (8.0%). To evaluate for the presence of plaque, CCTA had an overall sensitivity and specificity of 99% and 75%, respectively. In patients who underwent CCTA with a tube voltage of 100 kV, both sensitivity and specificity were 100%. The sensitivity and specificity of CCTA to identify plaque as calcified (fibrocalcific or calcific) vs noncalcified (soft or fibrous) were 87% and 96%, respectively. Overall, the accuracy of CCTA to detect the presence of plaque was 97%; the accuracy to detect plaque calcification was 94%.
CCTA offers excellent sensitivity and accuracy for plaque detection and morphology characterization in nonocclusive coronary segments. In addition, diagnostic accuracy is preserved with a reduced tube voltage protocol.
尽管血管内超声（IVUS）是目前斑块特征分析的金标准，但无创冠状动脉计算机断层扫描血管造影（CCTA）仍需进一步评估。CCTA检测斑块形态的能力尚不清楚。本研究的目的是评估CCTA在斑块检测和形态分析方面的诊断准确性。
31例患者接受了IVUS和CCTA检查。在左前降支、左旋支和右冠状动脉的非闭塞节段（狭窄<50%）通过两种方法评估斑块的存在情况。斑块形态分为：（1）正常；（2）软斑块或纤维斑块；（3）纤维钙化斑块；（4）钙化斑块。IVUS和CCTA的结果在节段对节段的基础上进行盲法比较，并根据CCTA管电压进行亚组分析。
31例患者（平均年龄56.2±8.6岁，27%为女性）共分析了152个节段。其中，42%的节段位于左前降支，32%位于左旋支，26%位于右冠状动脉。IVUS显示斑块形态为纤维斑块103个节段（68%），纤维钙化斑块31个节段（20%），钙化斑块6个节段（4.0%）；12个节段正常（8.0%）。为评估斑块的存在情况，CCTA的总体敏感性和特异性分别为99%和75%。在管电压为100 kV的CCTA检查患者中，敏感性和特异性均为100%。CCTA将斑块识别为钙化（纤维钙化或钙化）与非钙化（软斑块或纤维斑块）的敏感性和特异性分别为87%和96%。总体而言，CCTA检测斑块存在的准确性为97%；检测斑块钙化的准确性为94%。
CCTA在非闭塞性冠状动脉节段的斑块检测和形态特征分析方面具有出色的敏感性和准确性。此外，降低管电压方案时诊断准确性得以保持。
