Mintz G S, Popma J J, Pichard A D, Kent K M, Satler L F, Chuang Y C, Ditrano C J, Leon M B
Intravascular Ultrasound Imaging Laboratory, Washington Hospital Center, DC.
Circulation. 1995 Apr 1;91(7):1959-65. doi: 10.1161/01.cir.91.7.1959.
Target lesion calcium is a marker for significant coronary artery disease and a determinant of the success of transcatheter therapy.
Eleven hundred fifty-five native vessel target lesions in 1117 patients were studied by intravascular ultrasound (IVUS) and coronary angiography. The presence, magnitude, location, and distribution of IVUS calcium were analyzed and compared with the detection and classification (none/mild, moderate, and severe) by angiography. Angiography detected calcium in 440 of 1155 lesions (38%): 306 (26%) moderate calcium and 134 (12%) severe. IVUS detected lesion calcium in 841 of 1155 (73%, P < .0001 versus angiography). The mean arc of lesion calcium measured 115 +/- 110 degrees; the mean length measured 3.5 +/- 3.7 mm. Target lesion calcium was only superficial in 48%, only deep in 28%, and both superficial and deep in 24%. The mean arc of superficial calcium measured 85 +/- 108 degrees; the mean length measured 2.4 +/- 3.4 mm. Three hundred seventy-three of 1155 reference segments (32%) contained calcium (P < .0001 compared with lesion site). The mean arc of reference calcium measured 42 +/- 80 degrees; the mean length measured 1.7 +/- 3.6 mm. Only 44 (4%) had reference calcium in the absence of lesion calcium. Angiographic detection and classification of calcium depended on arcs, lengths, location, and distribution of lesion and reference segment calcium. By discriminant analysis, the classification function for predicting angiographic calcium included the arc of target lesion calcium, the arc of superficial calcium, the length of reference segment calcium, and the location of calcium within the lesion. This model correctly predicted the angiographic detection of calcification in 74.4% of lesions and the angiographic classification (none/moderate/severe) of calcium in 62.8% of lesions.
IVUS detected calcium in > 70% of lesions, significantly more often than standard angiography. Although angiography is moderately sensitive for the detection of extensive lesion calcium (sensitivity, 60% and 85% for three- and four-quadrant calcium, respectively), it is less sensitive for the presence of milder degrees.
靶病变钙化是严重冠状动脉疾病的一个标志物，也是经导管治疗成功与否的一个决定因素。
通过血管内超声（IVUS）和冠状动脉造影对1117例患者的1155个天然血管靶病变进行了研究。分析了IVUS钙化的存在、程度、位置和分布，并与造影检测及分类（无/轻度、中度和重度）进行了比较。造影在1155个病变中的440个（38%）检测到钙化：306个（26%）为中度钙化，134个（12%）为重度钙化。IVUS在1155个病变中的841个（73%）检测到病变钙化（与造影相比，P <.0001）。病变钙化的平均弧度为115±110度；平均长度为3.5±3.7毫米。靶病变钙化仅为浅表性的占48%，仅为深部的占28%，浅表和深部均有的占24%。浅表钙化的平均弧度为85±108度；平均长度为2.4±3.4毫米。1155个参考节段中的373个（32%）含有钙化（与病变部位相比，P <.0001）。参考钙化的平均弧度为42±80度；平均长度为1.7±3.6毫米。仅44个（4%）在无病变钙化的情况下有参考钙化。钙化的造影检测和分类取决于病变及参考节段钙化的弧度、长度、位置和分布。通过判别分析，预测造影钙化的分类函数包括靶病变钙化的弧度、浅表钙化的弧度、参考节段钙化的长度以及钙化在病变内的位置。该模型正确预测了74.4%病变的造影钙化检测以及62.8%病变的造影钙化分类（无/中度/重度）。
IVUS在70%以上的病变中检测到钙化，比标准造影检测到钙化的频率显著更高。虽然造影对广泛病变钙化的检测具有中度敏感性（对于三象限和四象限钙化，敏感性分别为60%和85%），但对较轻程度钙化的存在敏感性较低。
