Silveira de Souza V V, Soares Torres F, Hochhegger B, Watte G, Sartori G, Lucchese F, Azambuja Gonçalves B
Santa Casa de Misericórdia de Porto Alegre, Annes Dias St 295, Porto Alegre, Rio Grande do Sul, 90020-090, Brazil.
Santa Casa de Misericórdia de Porto Alegre, Annes Dias St 295, Porto Alegre, Rio Grande do Sul, 90020-090, Brazil.
Clin Radiol. 2017 Sep;72(9):745-750. doi: 10.1016/j.crad.2017.03.015. Epub 2017 Apr 13.
To evaluate the diagnostic performance of ultra-low-dose computed tomography (ULDCT) in comparison to standard coronary calcium score (CCS) acquisition for the evaluation of coronary artery calcification (CAC).
Standard CCS acquisition and ULDCT were performed in patients referred for coronary CT angiography for the evaluation of coronary artery disease. CAC in ULDCT was graded subjectively using a four-point scale (from 0, no calcification, to 3, severe calcification) for the complete study and for each individual coronary segment. The summation of all individual coronary segment scores generated an ULDCT total CAC score. ULDCT results were compared to standard Agatston score and sensitivity and specificity of ULDCT were calculated.
CCS and ULDCT were performed in 74 patients, with a mean DLP of 77.7 mGy·cm (±12.1) and 9.3 mGy·cm (±0.6), respectively (p<0.001). Coronary calcification was detected in 47 patients (63.5%) in standard CCS acquisition (median Agatston score of 41; interquartile range [IQR]:0263), in comparison to 42 patients (56.8%) in ULDCT (p<0.001). The sensitivity and specificity of the ULDCT total CAC score ≥1 was 80.9% and 85.2%, respectively, with an accuracy of 82.4%. The area under the receiver operating characteristic curve for the presence of CAC was 0.87.
ULDCT shows good sensitivity, specificity, and overall accuracy for the detection of coronary calcification with a markedly lower radiation dose in comparison to CCS. ULDCT is unlikely to miss coronary calcification in individuals with at least moderate calcium load (Agatston score >100).
评估超低剂量计算机断层扫描（ULDCT）与标准冠状动脉钙化积分（CCS）采集在评估冠状动脉钙化（CAC）方面的诊断性能。
对因评估冠状动脉疾病而接受冠状动脉CT血管造影的患者进行标准CCS采集和ULDCT检查。在ULDCT中，对整个研究以及每个单独的冠状动脉节段，使用四点量表（从0，无钙化，到3，严重钙化）对CAC进行主观分级。所有单个冠状动脉节段评分的总和产生ULDCT总CAC评分。将ULDCT结果与标准阿加斯顿积分进行比较，并计算ULDCT的敏感性和特异性。
74例患者接受了CCS和ULDCT检查，平均剂量长度乘积（DLP）分别为77.7 mGy·cm（±12.1）和9.3 mGy·cm（±0.6）（p<0.001）。标准CCS采集中47例患者（63.5%）检测到冠状动脉钙化（阿加斯顿积分中位数为41；四分位间距[IQR]：0 - 263），而ULDCT中为42例患者（56.8%）（p<0.001）。ULDCT总CAC评分≥1时的敏感性和特异性分别为80.9%和85.2%，准确性为82.4%。存在CAC的受试者操作特征曲线下面积为0.87。
与CCS相比，ULDCT在检测冠状动脉钙化方面具有良好的敏感性、特异性和总体准确性，且辐射剂量显著更低。对于至少有中度钙负荷（阿加斯顿积分>100）的个体，ULDCT不太可能漏诊冠状动脉钙化。
