Reproducibility of coronary atherosclerotic plaque characteristics in populations with low, intermediate, and high prevalence of coronary artery disease by multidetector computer tomography: a guide to reliable visual coronary plaque assessments
Reproducibility of coronary atherosclerotic plaque characteristics in populations with low, intermediate, and high prevalence of coronary artery disease by multidetector computer tomography: a guide to reliable visual coronary plaque assessments
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DOI：
10.1007/s10554-016-0932-y
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发表时间：
2016-10-01
影响因子：
2.1
通讯作者：
Kofoed, Klaus F.
中科院分区：
文献类型：
--
作者：
de Knegt, Martina C.;Linde, Jesper J.;Kofoed, Klaus F.
目的：评价320层多层计算机断层扫描(MDCT)在低、中、高三种冠心病患病率人群中冠状动脉斑块特征的观察者间一致性，并确定这些斑块特征的可重复性评估的决定因素。按年龄和性别匹配的150例患者、50例无症状的普通人群(冠心病患病率低)、50例有症状的非急性冠脉综合征(非急性冠脉综合征)患者(中度冠心病患病率)和50例急性冠脉综合征患者(冠心病患病率高)作为研究对象。由四位读者对所有冠状动脉节段的整体图像质量、可评估性、是否存在冠心病、冠状动脉狭窄、斑块成分、斑块焦点和点状钙化进行评估。观察者间的一致性用Fleiss‘s Kappa(Kappa)和组内相关(ICC)进行评估。广泛使用的临床参数(总体扫描质量、有无冠心病和确定冠状动脉狭窄)在四位读者中表现出很好的一致性(ICC=0.66，kappa=0.73，ICC=0.74)。当计入心率、体重指数、斑块位置和冠状动脉狭窄程度高于或低于50%时，观察者间对斑块成分、冠心病的存在和冠状动脉狭窄程度的一致性改善为良或优，(kappa=0.61，kappa=0.81，ICC=0.78)。点状钙化是研究中重复性最差的参数(kappa=0.33)。在不同亚群中，除斑块成分外，冠状动脉斑块特征的重复性一般随着冠心病患病率的增加而降低(对于低、中、高冠心病患病率，一致性限分别为+/-2.03、+/-1.96、+/-1.79)。除斑块状钙化外，320层多层螺旋CT可用于评价冠状动脉斑块的特征。重复性评估受心率、身体大小、斑块位置和管腔狭窄程度的影响。
To evaluate the interobserver agreement of visual coronary plaque characteristics by 320-slice multidetector computed tomography (MDCT) in three populations with low, intermediate and high CAD prevalence and to identify determinants for the reproducible assessment of these plaque characteristics. 150 patients, 50 asymptomatic subjects from the general population (low CAD prevalence), 50 symptomatic non-acute coronary syndrome (non-ACS) patients (intermediate CAD prevalence), and 50 ACS patients (high CAD prevalence), matched according to age and gender, were retrospectively enrolled. All coronary segments were evaluated for overall image quality, evaluability, presence of CAD, coronary stenosis, plaque composition, plaque focality, and spotty calcification by four readers. Interobserver agreement was assessed using Fleiss' Kappa (kappa) and intra-class correlation (ICC). Widely used clinical parameters (overall scan quality, presence of CAD, and determination of coronary stenosis) showed good agreement among the four readers, (ICC = 0.66, kappa = 0.73, ICC = 0.74, respectively). When accounting for heart rate, body mass index, plaque location, and coronary stenosis above/below 50 %, interobserver agreement for plaque composition, presence of CAD, and coronary stenosis improved to either good or excellent, (kappa = 0.61, kappa = 0.81, ICC = 0.78, respectively). Spotty calcification was the least reproducible parameter investigated (kappa = 0.33). Across subpopulations, reproducibility of coronary plaque characteristics generally decreased with increasing CAD prevalence except for plaque composition, (limits of agreement: +/- 2.03, +/- 1.96, +/- 1.79 for low, intermediate and high CAD prevalence, respectively). 320-slice MDCT can be used to assess coronary plaque characteristics, except for spotty calcification. Reproducibility estimates are influenced by heart rate, body size, plaque location, and degree of luminal stenosis.