双源 CT 检测心脏移植受者心脏移植血管病：与有创冠状动脉造影的比较。
Detection of cardiac allograft vasculopathy on dual source computed tomography in heart transplant recipients: comparison with invasive coronary angiography.
机构信息
Department of Cardiovascular Radiology and Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, India.
Department of Cardiology, , Sri Chitra Tirunal Institute of Medical Science and Technology, Trivandrum, Kerala, India.
出版信息
Br J Radiol. 2022 Jun 1;95(1134):20211237. doi: 10.1259/bjr.20211237. Epub 2022 Mar 8.
OBJECTIVE
We aimed to evaluate the diagnostic accuracy (DA) of dual-source CT coronary angiography (DSCTCA) against invasive coronary angiography (ICA) in assessing stenotic cardiac allograft vasculopathy (CAV) in heart transplant (HTX) recipients.
METHODS
Consecutive HTX recipients( = 38) on annual surveillance, underwent DSCTCA prior to ICA on a 192-detector 384-slice DSCT scanner. Cases were classified as no CAV (no stenosis), (any degree of stenosis) or (>50% stenosis).
RESULTS
Mean age was 33.66 ± 11.45 years (M:F = 27:11, median time from HTX-23.5 months). Prevalence of on DSCTCA and ICA was 44.7%( = 17) and 39.5%( = 15), respectively and that of was 21.1%( = 8) and 15.8%( = 6), respectively. 557 (96.7%) segments were interpretable on DSCTCA. Mean radiation dose was 4.24 ± 2.15 mSv. At patient-level, the sensitivity, specificity, positive-predictive value, negative-predictive value (NPV), and DA of DSCTCA for detection of and were 100%, 91.3%, 88.2%, 100%, 94.73% and 100%, 94%, 75%, 100%, 95% respectively. The same on segment-based analysis were 96%, 97.6%, 80%, 99.6%, 97.5% and 100%, 99.6%,86.7%,100%, 99.6%, respectively. There was excellent agreement between the two modalities for detection of and [κ = 0.892 and 0.826 (patient-level), 0.859 and 0.927 (segment-level)]. CAC score correlated significantly with the presence of on both modalities. A diagnosis of rejection on biopsy did not correlate with on DSCTCA or ICA.
CONCLUSION
High sensitivity and NPV of DSCTCA in the evaluation of stenotic CAV suggests that it can be an accurate and non-invasive alternative to ICA for routine surveillance of HTX recipients.
ADVANCES IN KNOWLEDGE
DSCTCA detects the stenotic CAV non-invasively in transplant recipients with high sensitivity, specificity and NPV when compared with catheter coronary angiography, at lower radiation doses. There is excellent agreement between CT angiography and catheter coronary angiography for detection of and . A diagnosis of rejection on biopsy does not correlate with on CT angiography or catheter angiography.
目的
评估双源 CT 冠状动脉成像（DSCTCA）在评估心脏移植（HTX）受者狭窄性心脏移植物血管病（CAV）方面相对于有创冠状动脉造影（ICA）的诊断准确性（DA）。
方法
连续接受年度监测的 HTX 受者（n=38）在 192 探测器 384 层 DSCT 扫描仪上进行 DSCTCA 检查，然后进行 ICA。将病例分为无 CAV（无狭窄）、（任何程度的狭窄）或（>50%狭窄）。
结果
平均年龄为 33.66±11.45 岁（M：F=27：11，HTX 后中位数时间为 23.5 个月）。DSCTCA 和 ICA 上 的患病率分别为 44.7%（n=17）和 39.5%（n=15）， 的患病率分别为 21.1%（n=8）和 15.8%（n=6）。557 个（96.7%）节段可在 DSCTCA 上进行解读。平均辐射剂量为 4.24±2.15mSv。在患者水平，DSCTCA 检测 和 的敏感性、特异性、阳性预测值、阴性预测值（NPV）和 DA 分别为 100%、91.3%、88.2%、100%、94.73%和 100%、94%、75%、100%、95%。基于节段的分析结果相似，分别为 96%、97.6%、80%、99.6%、97.5%和 100%、99.6%、86.7%、100%、99.6%。两种方法在检测 和 方面具有极好的一致性[κ=0.892 和 0.826（患者水平），0.859 和 0.927（节段水平）]。CAC 评分与两种方法检测到的 显著相关。活检诊断为排斥反应与 DSCTCA 或 ICA 上的 不相关。
结论
DSCTCA 在评估狭窄性 CAV 方面具有较高的敏感性和 NPV，表明它可以作为 HTX 受者常规监测的一种准确且非侵入性的替代方法，而辐射剂量较低。与导管冠状动脉造影相比，DSCTCA 在检测移植受者的狭窄性 CAV 时具有较高的敏感性、特异性和 NPV，与导管冠状动脉造影有极好的一致性。活检诊断为排斥反应与 CT 血管造影或导管血管造影上的 不相关。
知识进展
DSCTCA 在检测狭窄性 CAV 方面具有较高的敏感性、特异性和 NPV，与有创冠状动脉造影相比，其辐射剂量较低，可作为心脏移植受者常规监测的一种准确、非侵入性的替代方法。CT 血管造影与有创冠状动脉造影在检测 和 方面具有极好的一致性。活检诊断为排斥反应与 CT 血管造影或导管血管造影上的 不相关。
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