Predictors of inaccurate coronary arterial stenosis assessment by CT angiography.
Predictors of inaccurate coronary arterial stenosis assessment by CT angiography.
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DOI：
10.1016/j.jcmg.2013.02.011
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发表时间：
2013-09
期刊：
影响因子：
--
通讯作者：
Arbab-Zadeh A
中科院分区：
文献类型：
--
作者：
Yan RT;Miller JM;Rochitte CE;Dewey M;Niinuma H;Clouse ME;Vavere AL;Brinker J;Lima JA;Arbab-Zadeh A
研究与计算机断层扫描血管造影（CTA）诊断定量冠状动脉造影（QCA）定义的阻塞性冠状动脉疾病（CAD）不准确性相关的临床和影像学特征。虽然已经报告了CTA的诊断性能指标，但CTA诊断不准确性的预测因素数据很少。对入组CorE-64研究的291例患者的临床特征进行了检查。在中心核心实验室中盲法提取所有真阳性（N=237）、假阳性（N=115）、假阴性（N=159）和真阴性节段（N=511）随机子集（≥50%狭窄）的预定义CTA节段水平特征，QCA作为参考标准。确定与CTA诊断不准确性相应水平独立相关的因素。每例患者的钙评分≥1（OR=5.2，95%置信区间[CI] =1.1-24.6）和存在节段内钙化（OR=10.2 [5.2-19.8]）预测假阳性诊断。相反，无节段内钙化是假阴性诊断的独立预测因素（OR=2.0 [1.2-3.5]）。既往经皮血运重建与阻塞性CAD的患者级误诊独立相关（OR=4.2 [1.6-11.2]）。CTA上的特定节段特征，特别是节段迂曲（OR=3.5 [2.4-5.1]）、管腔口径较小（每1 mm增量OR=0.48 [0.36-0.63]）和近动脉静脉明显性（OR=2.1 [1.4-3.2]）与节段级误诊独立相关。获得更大的腔内对比增强独立地降低了假阴性诊断的风险（OR=0.96 [0.94-0.99]，每10-Hounsfield单位增量）。我们确定了临床和易于识别的影像学特征，预测QCA定义的阻塞性CAD的CT血管造影诊断不准确。了解这些特征并适当考虑这些特征可能会提高临床CTA解释的准确性。
To investigate clinical and imaging characteristics associated with diagnostic inaccuracy of computed tomography angiography (CTA) for detecting obstructive coronary artery disease (CAD) defined by quantitative coronary angiography (QCA). While diagnostic performance metrics of CTA have been reported, there are sparse data on predictors of diagnostic inaccuracy by CTA. Clinical characteristics of 291 patients enrolled in the CorE-64 study were examined. Pre-defined CTA segment-level characteristics of all true-positive (N=237), false-positive (N=115), false-negative (N=159), and a random subset of true-negative segments (N=511) for ≥50% stenosis with QCA as reference standard were blindly abstracted in a central core-laboratory. Factors independently associated with corresponding levels of CTA diagnostic inaccuracies were determined. A calcium score of ≥1 per patient (OR=5.2, 95% confidence interval [CI] =1.1–24.6) and the presence of within-segment calcification (OR=10.2 [5.2–19.8]) predicted false-positive diagnoses. Conversely, absence of within-segment calcification was an independent predictor of false-negative diagnosis (OR=2.0 [1.2–3.5]). Prior percutaneous revascularization was independently associated with patient-level misdiagnosis of obstructive CAD (OR=4.2 [1.6–11.2]). Specific segment characteristics on CTA, notably segment tortuosity (OR=3.5 [2.4–5.1], smaller luminal caliber (OR=0.48 [0.36–0.63] per 1-mm increment) and juxta-arterial vein conspicuity (OR=2.1 [1.4–3.2]) were independently associated with segment-level misdiagnoses. Attaining greater intra-luminal contrast enhancement independently lowered the risk for false-negative diagnosis (OR=0.96 [0.94–0.99], per 10-Hounsfield-Unit increment). We identified clinical and readily-discernable imaging characteristics predicting inaccurate CT angiography diagnosis of obstructive CAD defined by QCA. Knowledge and appropriate considerations of these features may improve accuracy in clinical CTA interpretation.
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影响因子：
5.9
作者：
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