Li Fang, He Qing, Xu Lixue, Zhou Yan, Sun Yufei, Wang Zhenchang, Xu Yinghao, Yang Zhenghan, He Yi
Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China.
Department of Radiology, Beijing Chest Hospital, Capital Medical University, Beijing, China.
Front Cardiovasc Med. 2022 Mar 21;9:828751. doi: 10.3389/fcvm.2022.828751. eCollection 2022.
Subtraction coronary CT angiography (CCTA) may reduce blooming and beam-hardening artifacts. This study aimed to assess its value in improving the diagnostic accuracy of readers with different experience levels.
We prospectively enrolled patients with target segment who underwent CCTA and invasive coronary angiography (ICA). Target segment images were independently evaluated by three groups of radiologists with different experience levels with CCTA using ICA as the standard reference. Diagnostic accuracy was measured by the area under the curve (AUC), using ≥50% stenosis as the cut-off value.
In total, 134 target segments with severe calcification from 47 patients were analyzed. The mean specificity of conventional CCTA for each group ranged from 22.4 to 42.2%, which significantly improved with subtraction CCTA, ranging from 81.3 to 85.7% (all < 0.001). The mean sensitivity of conventional CCTA for each group ranged from 83.3 to 88.0%. Following calcification subtraction, the mean sensitivity decreased for the novice ( < 0.001) and junior ( = 0.017) radiologists but was unchanged for the senior radiologists ( = 0.690). With subtraction CCTA, the mean AUCs of CCTA significantly increased: values ranged from 0.53, 0.54, and 0.61 to 0.70, 0.74, and 0.85 for the novice, junior, and senior groups (all < 0.001).
Subtraction CCTA could improve the diagnostic accuracy of radiologists at all experience levels of CCTA interpretation.
冠状动脉CT血管造影（CCTA）减影可减少伪影和硬化伪影。本研究旨在评估其在提高不同经验水平阅片者诊断准确性方面的价值。
我们前瞻性纳入了接受CCTA和有创冠状动脉造影（ICA）检查的有靶血管节段的患者。以ICA作为标准参考，由三组不同经验水平的放射科医生独立评估靶血管节段图像。以曲线下面积（AUC）衡量诊断准确性，以≥50%狭窄为截断值。
共分析了47例患者的134个有严重钙化的靶血管节段。每组传统CCTA的平均特异性为22.4%至42.2%，CCTA减影后显著提高，为81.3%至85.7%（均P<0.001）。每组传统CCTA的平均敏感性为83.3%至88.0%。钙化减影后，新手（P<0.001）和初级（P=0.017）放射科医生的平均敏感性降低，但高级放射科医生的平均敏感性无变化（P=0.690）。采用CCTA减影后，CCTA的平均AUC显著增加：新手组、初级组和高级组的值分别从0.53、0.54和0.61增加到0.70、0.74和0.85（均P<0.001）。
CCTA减影可提高所有CCTA解读经验水平的放射科医生的诊断准确性。
