Diagnostic Performance of Coronary Angiography by 64-Row CT
Diagnostic Performance of Coronary Angiography by 64-Row CT
复制标题
DOI：
10.1056/nejmoa0806576
复制
发表时间：
2008-11-27
影响因子：
158.5
通讯作者：
Lima, Joao A. C.
中科院分区：
文献类型：
--
作者：
Miller, Julie M.;Rochitte, Carlos E.;Lima, Joao A. C.
背景资料：涉及64 detectors.Methods：我们进行了一项多中心研究，以检查64排，0.5毫米多排CT血管造影的准确性相比，传统的冠状动脉造影在可疑的冠状动脉疾病患者的准确性。9家临床试验机构入组了在常规冠状动脉造影术前接受钙评分和多排螺旋CT血管造影术的患者。在291例钙化评分为600或更低的患者中，在独立的核心实验室通过CT和常规血管造影术分析直径为1.5 mm或更大的节段。50%或以上的狭窄被认为是阻塞性的。接受者工作特征曲线（AUC）下的面积被用来评估诊断准确性相对于传统的血管造影和随后的血运重建状态，而疾病的严重程度进行了评估与使用修改后的杜克冠状动脉疾病指数。定量CT血管造影检测或排除根据常规血管造影50%或以上狭窄的基于患者的诊断准确性显示AUC为0.93（95%置信区间[CI]，0.90至0.96），灵敏度为85%（95% CI，79至90），特异性为90%（95% CI，83至94），阳性预测值为91%（95% CI，86至95），阴性预测值为83%（95% CI，75至89）。CT血管造影术在识别随后接受血运重建的患者方面与传统血管造影术相似：多排CT血管造影术的AUC为0.84（95% CI，0.79 - 0.88），传统血管造影术的AUC为0.82（95% CI，0.77 - 0.86）。对866支血管进行的每支血管分析得出的AUC为0.91（95% CI，0.88 - 0.93）。通过CT和常规血管造影确定的疾病严重程度具有良好的相关性（r=0.81; 95%CI，0.76至0.84）。两名患者有重要的反应，造影剂后CT angiography.Conclusions：多层螺旋CT血管造影准确识别阻塞性冠状动脉疾病的存在和严重程度，随后在有症状的患者血运重建。阴性和阳性预测值表明，目前多层螺旋CT冠状动脉造影还不能取代常规冠状动脉造影。（ClinicalTrials.gov编号，NCT 00738218）。
Background: The accuracy of multidetector computed tomographic (CT) angiography involving 64 detectors has not been well established.Methods: We conducted a multicenter study to examine the accuracy of 64-row, 0.5-mm multidetector CT angiography as compared with conventional coronary angiography in patients with suspected coronary artery disease. Nine centers enrolled patients who underwent calcium scoring and multidetector CT angiography before conventional coronary angiography. In 291 patients with calcium scores of 600 or less, segments 1.5 mm or more in diameter were analyzed by means of CT and conventional angiography at independent core laboratories. Stenoses of 50% or more were considered obstructive. The area under the receiver-operating-characteristic curve (AUC) was used to evaluate diagnostic accuracy relative to that of conventional angiography and subsequent revascularization status, whereas disease severity was assessed with the use of the modified Duke Coronary Artery Disease Index.Results: A total of 56% of patients had obstructive coronary artery disease. The patient-based diagnostic accuracy of quantitative CT angiography for detecting or ruling out stenoses of 50% or more according to conventional angiography revealed an AUC of 0.93 (95% confidence interval [CI], 0.90 to 0.96), with a sensitivity of 85% (95% CI, 79 to 90), a specificity of 90% (95% CI, 83 to 94), a positive predictive value of 91% (95% CI, 86 to 95), and a negative predictive value of 83% (95% CI, 75 to 89). CT angiography was similar to conventional angiography in its ability to identify patients who subsequently underwent revascularization: the AUC was 0.84 (95% CI, 0.79 to 0.88) for multidetector CT angiography and 0.82 (95% CI, 0.77 to 0.86) for conventional angiography. A per-vessel analysis of 866 vessels yielded an AUC of 0.91 (95% CI, 0.88 to 0.93). Disease severity ascertained by CT and conventional angiography was well correlated (r=0.81; 95% CI, 0.76 to 0.84). Two patients had important reactions to contrast medium after CT angiography.Conclusions: Multidetector CT angiography accurately identifies the presence and severity of obstructive coronary artery disease and subsequent revascularization in symptomatic patients. The negative and positive predictive values indicate that multidetector CT angiography cannot replace conventional coronary angiography at present. (ClinicalTrials.gov number, NCT00738218.).