Accuracy of 16-row multidetector computed tomography for the assessment of coronary artery stenosis
Accuracy of 16-row multidetector computed tomography for the assessment of coronary artery stenosis
复制标题
DOI：
10.1001/jama.296.4.403
复制
发表时间：
2006-07-26
影响因子：
120.7
通讯作者：
Hoffmann, Martin H. K.
中科院分区：
文献类型：
--
作者：
Garcia, Mario J.;Lessick, Jonathan;Hoffmann, Martin H. K.
背景多排螺旋CT（MDCT）是一种无创性评价冠状动脉解剖结构的方法。目的通过多中心研究，探讨16排MDCT对阻塞性冠状动脉疾病的诊断准确性。从2004年6月到2005年3月，11个参与研究的研究中心前瞻性地招募了238名临床转诊接受非急诊冠状动脉造影的患者2005.在低剂量MDCT扫描评估冠状动脉钙后，187例Agatston评分低于600的患者接受了对比增强MDCT。MDCT后1 ~ 14天行常规血管造影。常规血管造影和MDCT研究由独立的核心实验室进行分析。主要结果测量基于节段和基于患者的检测管腔狭窄超过50%的敏感性和特异性（管腔直径）和超过70%结果在1629个直径大于2 mm的非支架植入节段中，187例中59例（32%）血管狭窄超过50%者89例（5.5%）。在1629个节段中，71%可在MDCT上评价。在将所有不可评估的节段作为阳性删失后，检测超过50%管腔狭窄的灵敏度为89%，特异性为65%，阳性预测值为13%，阴性预测值为99%。在基于患者的分析中，检测至少有1个阳性片段的患者的灵敏度为98%;特异性为54%;阳性预测值为50%;阴性预测值为99%。在将所有不可评估的节段作为阳性删失后，检测70%以上管腔狭窄的灵敏度为94%，特异性为67%，阳性预测值为6%，阴性预测值为99%。在基于患者的分析中，检出至少1个阳性节段的患者的敏感性为94%，特异性为51%，阳性预测值为28%，阴性预测值为98%.Conclusion16排螺旋CT冠状动脉造影的局限性在于不可评价的病例数多，假阳性率高。因此，其在临床实践中的常规实施不合理。然而，鉴于其高灵敏度和阴性预测值，16排MDCT可能有助于排除假阳性或不确定的负荷试验结果可疑的选定患者的冠状动脉疾病。
Context Multidetector computed tomography (MDCT) has been proposed as a non-invasive method to evaluate coronary anatomy.Objective To determine the diagnostic accuracy of 16-row MDCT for the detection of obstructive coronary disease based exclusively on quantitative analysis and performed in a multicenter study.Design, Setting, and Patients Eleven participating sites prospectively enrolled 238 patients who were clinically referred for nonemergency coronary angiography from June 2004 through March 2005. Following a low-dose MDCT scan to evaluate coronary artery calcium, 187 patients with an Agatston score of less than 600 underwent contrast-enhanced MDCT. Conventional angiography was performed 1 to 14 days after MDCT. Conventional angiographic and MDCT studies were analyzed by independent core laboratories.Main Outcome Measures Segment-based and patient-based sensitivities and specificities for the detection of luminal stenosis of more than 50% ( of luminal diameter) and more than 70% ( of luminal diameter) based on quantitative coronary angiography.Results Of 1629 nonstented segments larger than 2 mm in diameter, there were 89 (5.5%) in 59 (32%) of 187 patients with stenosis of more than 50% by conventional angiography. Of the 1629 segments, 71% were evaluable on MDCT. After censoring all nonevaluable segments as positive, the sensitivity for detecting more than 50% luminal stenoses was 89%; specificity, 65%; positive predictive value, 13%; and negative predictive value, 99%. In a patient-based analysis, the sensitivity for detecting patients with at least 1 positive segment was 98%; specificity, 54%; positive predictive value, 50%; and negative predictive value, 99%. After censoring all nonevaluable segments as positive, the sensitivity for detecting more than 70% luminal stenoses was 94%; specificity, 67%; positive predictive value, 6%; and negative predictive value, 99%. In a patient-based analysis, the sensitivity for detecting patients with at least 1 positive segment was 94%; specificity, 51%; positive predictive value, 28%; and negative predictive value, 98%.Conclusions The results of this study indicate that MDCT coronary angiography performed with 16-row scanners is limited by a high number of nonevaluable cases and a high false-positive rate. Thus, its routine implementation in clinical practice is not justified. Nevertheless, given its high sensitivity and negative predictive value, 16-row MDCT may be useful in excluding coronary disease in selected patients in whom a false-positive or inconclusive stress test result is suspected.