Department of Radiology, Seoul National University Bundang Hospital, Sungnam, Korea.
Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea.
Eur Radiol. 2018 Apr;28(4):1356-1364. doi: 10.1007/s00330-017-5095-2. Epub 2017 Oct 23.
To evaluate the clinical significance of discrepant lesions between coronary computed tomography angiography (CCTA) and invasive coronary angiography (ICA) in a longitudinal study.
In 220 patients with suspected coronary artery disease (CAD) who underwent both 256-row CCTA and ICA, the obstructive CAD (≥ 50% stenosis) on CCTA was compared with that on ICA as the reference standard. We analysed the causes of the discrepancy between CCTA and ICA. During a 40-month follow-up period, major adverse cardiac events (MACE) were assessed.
Discordance between CCTA and ICA was observed in 121 of the 3166 coronary artery segments (3.8%). Common causes were calcification (45.9%) and positive remodelling (PR) (29.6%) in 83 false positive lesions, and noise (40.0%) and motion artefact (37.8%) in 38 false negative lesions. MACE occurred in seven lesions among the discrepant lesions; six among the 29 PR lesions (20.7%) and one among the 53 calcified lesions (1.9%). With respect to the prediction power of MACE in an intermediate stenosis, the CCTA-related value including PR was higher than the ICA-related value.
PR was a frequent cause of MACE among the false positive lesions on CCTA. Therefore, the presence of PR on CCTA may suggest clinical significance, although it can be missed by ICA.
• Compared to ICA, PR in CCTA may be cause of false positive lesion. • CCTA-related value including PR shows higher prediction power of MACE than ICA-related value. • PR reflects atherosclerotic burden that can be related to cardiac events. • PR in CCTA should be observed carefully, even if it is false positive.
在一项纵向研究中评估冠状动脉计算机断层扫描血管造影术（CCTA）与有创冠状动脉造影术（ICA）之间不一致病变的临床意义。
在 220 例疑似冠心病（CAD）患者中，这些患者同时接受了 256 排 CCTA 和 ICA 检查，以 CCTA 上的阻塞性 CAD（≥50%狭窄）为参考标准，比较 CCTA 与 ICA 之间的病变差异。我们分析了 CCTA 与 ICA 之间差异的原因。在 40 个月的随访期间，评估了主要不良心脏事件（MACE）。
在 3166 个冠状动脉节段中，有 121 个（3.8%）节段的 CCTA 与 ICA 不一致。83 个假阳性病变中常见的原因是钙化（45.9%）和正性重构（PR）（29.6%），38 个假阴性病变中常见的原因是噪声（40.0%）和运动伪影（37.8%）。在不一致病变中，有 7 个病变发生了 MACE；29 个 PR 病变中有 6 个（20.7%），53 个钙化病变中有 1 个（1.9%）。对于中间狭窄的 MACE 预测能力，包括 PR 的 CCTA 相关值高于 ICA 相关值。
PR 是 CCTA 假阳性病变中发生 MACE 的常见原因。因此，尽管 ICA 可能会漏诊，但 CCTA 上的 PR 可能提示病变有临床意义。
与 ICA 相比，CCTA 中的 PR 可能是假阳性病变的原因。
包括 PR 的 CCTA 相关值比 ICA 相关值具有更高的 MACE 预测能力。
PR 反映了动脉粥样硬化负荷，与心脏事件有关。
即使是假阳性，CCTA 上的 PR 也应仔细观察。
