静脉注射电子束计算机断层扫描冠状动脉造影术用于冠状动脉狭窄节段分析。

Intravenous electron-beam computed tomographic coronary angiography for segmental analysis of coronary artery stenoses.

作者信息

Schmermund A, Rensing B J, Sheedy P F, Bell M R, Rumberger J A

机构信息

Department of Internal Medicine, Mayo Clinic and Foundation, Rochester, Minnesota, USA.

出版信息

J Am Coll Cardiol. 1998 Jun;31(7):1547-54. doi: 10.1016/s0735-1097(98)00132-6.

DOI:10.1016/s0735-1097(98)00132-6

PMID:9626833

Abstract

OBJECTIVES

We sought to identify and localize significant coronary stenoses on a segmental basis by electron-beam computed tomography (EBCT) and intravenous administration of a contrast agent.

BACKGROUND

The clinical applicability and limitations of intravenous EBCT coronary angiography have not been defined.

METHODS

EBCT was performed within 24 h of selective coronary angiography (SCA) in 28 patients (19 men and 9 women, mean [+/-SD] age 60 +/- 10 years). After examination for coronary calcium, EBCT coronary angiography was performed using overlapping slices (in-plane resolution 0.34 to 0.41 mm) with a nominal slice thickness of 1 mm. Based on quantitative analysis of SCA, lumen diameter narrowing > or = 50% (i.e., significant stenoses) was evaluated in 8 (major) or 12 (including side branches) coronary artery segments, using both two-dimensional (tomographic) and three-dimensional (volume) data sets.

RESULTS

Of the 330 segments assessable by SCA, 237 (72%) were visualized by EBCT. The sensitivity (+/-SE) for detection of significant stenoses was 82 +/- 6%; specificity was 88 +/- 2%; positive and negative predictive values were 57 +/- 7% and 96 +/- 2%, respectively; and overall accuracy was 87 +/- 2%. If only eight (major) coronary artery segments were considered, 194 (88%) of 221 segments were visualized, and the overall accuracy was 90 +/- 2%. Seven (18%) of 38 significantly stenotic segments were classified as having < 50% stenoses by EBCT. Six of these segments (86%), but only 9 (29%) of the 31 correctly classified stenotic segments, were severely calcified (area > 20 mm2, p = 0.02). In 23 (12%) of 199 nonstenotic segments falsely classified as having > or = 50% stenosis by EBCT, the lumen diameter was significantly smaller than that of the segments correctly classified as negative (mean [+/-SD] 1.5 +/- 0.8 vs. 2.9 +/- 1.1 mm, p < 0.001).

CONCLUSIONS

Intravenous EBCT coronary angiography allows for accurate segmental evaluation of significant disease in the major coronary arteries and may be of value for ruling out significant disease. The main determinant of false negative results is substantial segmental calcification, whereas the main determinant of false positive results is small vessel size.

摘要

目的

我们试图通过电子束计算机断层扫描（EBCT）和静脉注射造影剂，在节段基础上识别并定位显著的冠状动脉狭窄。

背景

静脉内EBCT冠状动脉造影的临床适用性和局限性尚未明确。

方法

对28例患者（19例男性和9例女性，平均[±标准差]年龄60±10岁）在选择性冠状动脉造影（SCA）的24小时内进行EBCT检查。在检查冠状动脉钙化后，使用标称层厚1mm的重叠切片（平面分辨率0.34至0.41mm）进行EBCT冠状动脉造影。基于SCA的定量分析，使用二维（断层）和三维（容积）数据集，在8条（主要）或12条（包括侧支）冠状动脉节段中评估管腔直径狭窄≥50%（即显著狭窄）。

结果

在330个可通过SCA评估的节段中，237个（72%）可通过EBCT显示。检测显著狭窄的敏感性（±标准误）为82±6%；特异性为88±2%；阳性和阴性预测值分别为57±7%和96±2%；总体准确性为87±2%。如果仅考虑8条（主要）冠状动脉节段，221个节段中的194个（88%）可显示，总体准确性为90±2%。38个显著狭窄节段中有7个（18%）被EBCT分类为狭窄<50%。这些节段中有6个（86%）严重钙化（面积>20mm2，p=0.02），但在31个正确分类的狭窄节段中只有9个（29%）严重钙化。在199个非狭窄节段中，有23个（12%）被EBCT错误分类为狭窄≥50%，其管腔直径明显小于正确分类为阴性的节段（平均[±标准差]1.5±0.8 vs. 2.9±1.1mm，p<0.001）。