Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Japan.
Department of Radiology, Chiba University Hospital, Japan.
Intern Med. 2023 Jan 15;62(2):169-176. doi: 10.2169/internalmedicine.9509-22. Epub 2022 Jun 7.
Objective High-quality images can be obtained with 320-slice computed tomography (CT) with model-based iterative reconstruction (MBIR). We therefore investigated the diagnostic accuracy of 320-slice CT with MBIR for detecting significant coronary artery stenosis. Methods This was a retrospective study of 160 patients who underwent coronary CT and invasive coronary angiography (ICA). The first 100 consecutive patients (Group 1) underwent 320-slice CT without MBIR or small-focus scanning. The next 60 consecutive patients (Group 2) underwent 320-slice CT with both MBIR and small-focus scanning. Patients who underwent coronary artery bypass surgery were excluded. The diagnostic performance of 320-slice CT without MBIR or small-focus scanning and 320-slice CT with both of them, with ICA regarded as a reference standard, was compared to detect significant coronary artery stenosis (≥70% on CT, ≥75% on ICA). Results In a patient-based analysis, the sensitivity, specificity, and overall accuracy of detection of significant stenosis on CT against ICA were 95%, 85%, and 91% in Group 1, and 93%, 83%, and 90% in Group 2, respectively. No significant differences were observed between the two groups in the patient- and segment-based analyses. However, among cases with a severe coronary artery calcium score >400 (31 cases in Group 1 and 28 in Group 2), the specificity and overall accuracy were significantly higher (all p<0.01) in Group 2 than in Group 1 according to the segment-based analysis. Conclusion The diagnostic accuracy of the detection of coronary artery stenosis on CT was improved using 320-slice CT with MBIR.
目的 采用基于模型的迭代重建（MBIR）的 320 层 CT 可获得高质量的图像。因此，我们研究了 MBIR 对检测冠状动脉显著狭窄的诊断准确性。
方法 这是一项回顾性研究，纳入了 160 例行冠状动脉 CT 和有创冠状动脉造影（ICA）的患者。前 100 例连续患者（第 1 组）行无 MBIR 或小焦点扫描的 320 层 CT。接下来的 60 例连续患者（第 2 组）行 MBIR 和小焦点扫描的 320 层 CT。排除行冠状动脉旁路手术的患者。以 ICA 为参考标准，比较无 MBIR 或小焦点扫描的 320 层 CT 和两者均有的 320 层 CT 的诊断性能，以检测冠状动脉显著狭窄（CT 上≥70%，ICA 上≥75%）。
结果 在患者为基础的分析中，第 1 组 CT 检测显著狭窄的敏感性、特异性和总体准确性分别为 95%、85%和 91%，第 2 组分别为 93%、83%和 90%。两组患者和节段的分析中未见差异。然而，在严重冠状动脉钙评分>400（第 1 组 31 例，第 2 组 28 例）的病例中，根据节段分析，第 2 组的特异性和总体准确性明显更高（均 p<0.01）。
结论 使用 MBIR 的 320 层 CT 可提高 CT 检测冠状动脉狭窄的诊断准确性。
