320排计算机断层扫描对冠状动脉粥样硬化斑块特征的诊断准确性：与血管内光学相干断层扫描的比较
Diagnostic Accuracy of 320-Row Computed Tomography for Characterizing Coronary Atherosclerotic Plaques: Comparison with Intravascular Optical Coherence Tomography.
作者信息
Ybarra Luiz F, Szarf Gilberto, Ishikawa Walther, Chamié Daniel, Caixeta Adriano, Puri Rishi, Perin Marco A
机构信息
London Health Science Centre, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada; Department of Interventional Cardiology, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
Department of Interventional Cardiology, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
出版信息
Cardiovasc Revasc Med. 2020 May;21(5):640-646. doi: 10.1016/j.carrev.2019.08.010. Epub 2019 Aug 15.
BACKGROUND/PURPOSE: This study sought to determine the diagnostic accuracy of 320-row computed tomography (320CT) for characterizing coronary atherosclerotic plaques in comparison with optical coherence tomography (OCT).
METHODS/MATERIALS: From 32 patients, 42 coronary segments were evaluated and co-registered by both 320CT and OCT. 320CT vulnerable plaque characteristics included low attenuation plaque (LAP) (<30HU), napkin-ring sign (NRS), positive remodeling (PR) and spotty calcification (SC). The presence of macrophage, neovascularization and cholesterol crystals was also determined by OCT.
RESULTS
Minimal lumen area was 2.78 ± 1.23 mm by OCT and 3.29 ± 1.49 mm by 320CT (p < 0.001). Noncalcified plaques were classified accordingly by both methods in 88.2% of the cases (p = 0.005). There was no association between any 320CT plaque type and OCT fibroatheroma (p = 0.62). The combination of 2 or more of the 320CT vulnerable plaque characteristics was associated with the presence of macrophage (74.2 vs. 25.8%; p = 0.034) and cholesterol crystals (85.7 vs. 14.3%; p = 0.04), but not with neovascularization (p = 0.65). The presence of all four characteristics demonstrated an accuracy of 75.1% for detecting OCT fibroatheroma.
CONCLUSIONS
320CT is useful for non-invasive evaluation of calcified and noncalcified tissue characteristics of coronary atheroma. The combination of all four 320CT vulnerable plaque characteristics provided the highest accuracy for detecting fibroatheromas.
SUMMARY
320CT is useful for non-invasive evaluation of calcified and noncalcified tissue characteristics of coronary atheroma. The combination of all 320CT vulnerable plaque characteristics (low attenuation plaque (<30HU), napkin-ring sign, positive remodeling and spotty calcification) provided the highest accuracy for detecting fibroatheromas compared to optical coherence tomography.
背景/目的：本研究旨在确定320排计算机断层扫描（320CT）与光学相干断层扫描（OCT）相比，在冠状动脉粥样硬化斑块特征诊断方面的准确性。
方法/材料：对32例患者的42个冠状动脉节段进行评估，并通过320CT和OCT进行配准。320CT易损斑块特征包括低密度斑块（LAP）（<30HU）、餐巾环征（NRS）、阳性重构（PR）和斑点状钙化（SC）。OCT还用于确定巨噬细胞、新生血管和胆固醇结晶的存在情况。
结果
OCT测量的最小管腔面积为2.78±1.23mm，320CT测量的为3.29±1.49mm（p<0.001）。两种方法对非钙化斑块的分类符合率为88.2%（p=0.005）。320CT的任何斑块类型与OCT纤维粥样瘤之间均无关联（p=0.62）。320CT易损斑块特征中两种或更多特征的组合与巨噬细胞（74.2%对25.8%；p=0.034）和胆固醇结晶（85.7%对14.3%；p=0.04）的存在相关，但与新生血管无关（p=0.65）。所有四个特征的存在对检测OCT纤维粥样瘤的准确率为75.1%。
结论
320CT有助于对冠状动脉粥样硬化的钙化和非钙化组织特征进行无创评估。320CT的所有四个易损斑块特征的组合在检测纤维粥样瘤方面具有最高的准确性。
总结
320CT有助于对冠状动脉粥样硬化的钙化和非钙化组织特征进行无创评估。与光学相干断层扫描相比，320CT的所有易损斑块特征（低密度斑块（<30HU）、餐巾环征、阳性重构和斑点状钙化）的组合在检测纤维粥样瘤方面具有最高的准确性。
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