From the Department of Cardiovascular Imaging, Centro Cardiologico Monzino, IRCCS, Via C. Parea 4, 20138 Milan, Italy (D.A., G.P., S.M., E.C., M.G., V.V., A.A., A.B., A.F., M.E.M., V.B., V.D., A.C., C.F., A.L.B., M.P.); Department of Clinical Sciences and Community Health, Cardiovascular Section (D.A., C.F.), and Luigi Sacco Department of Biomedical and Clinical Sciences (A.L.B.), University of Milan, Milan, Italy; and University of Piemonte Orientale Amedeo Avogadro, Novara, Italy (M.P.).
Radiology. 2017 Sep;284(3):676-684. doi: 10.1148/radiol.2017161779. Epub 2017 Apr 26.
Purpose To assess image quality, interpretability, diagnostic accuracy, and radiation exposure of a computed tomography (CT) scanner with 16-cm coverage and 230-µm spatial resolution at coronary artery evaluation in patients with atrial fibrillation (AF) by using invasive coronary angiography (ICA) as the reference method and to compare the results with those obtained in patients with sinus rhythm (SR). Materials and Methods Written informed consent and institutional ethics committee approval were obtained. Between March 2015 and February 2016, 166 consecutive patients were prospectively enrolled (83 with AF, 83 with SR). They underwent ICA and coronary CT angiography performed with a whole-heart CT scanner. Image quality, coronary segment interpretability, effective dose (ED), and diagnostic accuracy were assessed at CT angiography and were compared with those attained with ICA. Diagnostic performance of the groups was compared with the pairwise McNemar test. Results Mean heart rate during scanning was 83 beats per minute ± 21 (standard deviation) in the AF group and 63 beats per minute ± 14 in the SR group (P < .01). Coronary interpretability was 98.5% in the AF group and 98.4% in the SR group (P = .96). In a segment-based analysis, sensitivity and specificity in the detection of coronary stenosis of more than 50% compared with detection of ICA were 96.4% and 98.7%, respectively, in the chronic AF group (P = .98) and 95.6% and 98.1%, respectively, in the SR group (P = .32). In a patient-based analysis, sensitivity and specificity were 95.2% and 97.6%, respectively, in the chronic AF group (P = .95) and 97.8% and 94.7%, respectively, in the SR group (P = .93). Conclusion Whole-heart CT enables evaluation of coronary arteries with high image quality, low radiation exposure, and high diagnostic accuracy in patients with chronic AF, with a diagnostic performance similar to that in patients with SR. RSNA, 2017 Online supplemental material is available for this article.
目的 通过以有创性冠状动脉造影（ICA）作为参考方法，评估在心房颤动（AF）患者中使用 16cm 覆盖范围和 230μm 空间分辨率的 CT 扫描仪进行冠状动脉评估的图像质量、可解读性、诊断准确性和辐射暴露，并将结果与窦性心律（SR）患者进行比较。
材料与方法 获得书面知情同意书和机构伦理委员会批准。2015 年 3 月至 2016 年 2 月，前瞻性纳入 166 例连续患者（83 例 AF，83 例 SR）。他们接受了 ICA 和使用全心 CT 扫描仪进行的冠状动脉 CT 血管造影。在 CT 血管造影时评估图像质量、冠状动脉节段可解读性、有效剂量（ED）和诊断准确性，并与 ICA 获得的结果进行比较。使用配对 McNemar 检验比较两组的诊断性能。
结果 在 AF 组中，扫描时的平均心率为 83 次/分钟±21（标准差），在 SR 组中为 63 次/分钟±14（P<.01）。AF 组的冠状动脉可解读性为 98.5%，SR 组为 98.4%（P=.96）。在基于节段的分析中，与 ICA 相比，慢性 AF 组中冠状动脉狭窄程度大于 50%的检测敏感性和特异性分别为 96.4%和 98.7%（P=.98），SR 组分别为 95.6%和 98.1%（P=.32）。在基于患者的分析中，慢性 AF 组的敏感性和特异性分别为 95.2%和 97.6%（P=.95），SR 组分别为 97.8%和 94.7%（P=.93）。
结论 在慢性 AF 患者中，全心 CT 能够以高图像质量、低辐射暴露和高诊断准确性评估冠状动脉，其诊断性能与 SR 患者相似。RSNA，2017 年在线补充材料可用于本文。
