Reliable noninvasive coronary angiography with fast submillimeter multislice spiral computed tomography
Reliable noninvasive coronary angiography with fast submillimeter multislice spiral computed tomography
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DOI：
10.1161/01.cir.0000037222.58317.3d
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发表时间：
2002-10-15
期刊：
影响因子：
37.8
通讯作者：
de Feyter, PJ
中科院分区：
文献类型：
--
作者：
Nieman, K;Cademartiri, F;de Feyter, PJ
多层螺旋CT（MSCT）是一种很有前途的无创冠状动脉造影技术，但由于运动伪影和钙化导致的不完全可解释性，其临床应用仍然有限。（53名男性，年龄58 +/- 12岁）疑似阻塞性冠状动脉疾病，使用16层螺旋CT扫描仪（0.42-s旋转时间，12X0.75-mm探测器准直）进行ECG门控MSCT血管造影。34名患者接受了额外的β受体阻滞剂（平均心率：56 +/- 6 min（-1））。注射造影剂后，在大约20秒的屏气期间采集所有数据。左主干（LM）、左前降支（LAD）、左回旋支（LCX）和右冠状动脉（RCA），包括大于或等于2.0 mm的侧支，由两名盲法观察者独立评估，并筛选大于或等于50%的狭窄。将共识阅读与定量冠状动脉造影进行比较。58例MSCT检查成功。在231个评价分支中，有86个明显病变。在不排除分支的情况下，识别大于或等于50%阻塞分支的敏感性、特异性、阳性预测值和阴性预测值分别为95%（82/86）、86%（125/145）、80%（82/102）和97%（125/129）。LM、LAD、RCA和LCX的总体准确性分别为100%、91%、86%和81%。没有未检测到的LM、LAD或RCA分支阻塞。78%（45/58）的患者将患者分类为无、单支或多支血管病变，准确率较高，无明显阻塞的患者被错误地排除。结论：MSCT技术的改进结合心率控制，可以可靠地非侵入性检测阻塞性冠状动脉疾病。
Background-Multislice spiral computed tomography (MSCT) is a promising technique for noninvasive coronary angiography, although clinical application has remained limited because of frequently incomplete interpretability, caused by motion artifacts and calcifications.Methods and Results-In 59 patients (53 male, aged 58 +/- 12 years) with suspected obstructive coronary, artery disease, ECG-gated MSCT angiography was performed with a 16-slice MSCT scanner (0.42-s rotation time, 12X0.75-mm detector collimation). Thirty-four patients were given additional beta-blockers (average heart rate: 56 +/- 6 min(-1)). After contrast injection, all data were acquired during an approximately 20-s breath hold. The left main (LM), left anterior descending (LAD), left circumflex (LCX), and right coronary artery (RCA), including greater than or equal to2.0-mm side branches, were independently evaluated by two blinded observers and screened for greater than or equal to50% stenoses. The consensus reading was compared with quantitative coronary angiography. MSCT was successful in 58 patients. Eighty-six of the 231 evaluated branches were significantly diseased. Without exclusion of branches, the sensitivity, specificity and positive and negative predictive value to identify greater than or equal to50% obstructed branches was 95% (82/86), 86% (125/145), 80% (82/102), and 97% (125/129), respectively. The overall accuracy for the LM, LAD, RCA, and LCX was 100%, 91%, 86%, and 81%, respectively. No obstructed LM, LAD, or RCA branches remained undetected. Classification of patients as having no, single, or multivessel disease was accurate in 78% (45/58) of patients and no patients with significant obstructions were incorrectly excluded.Conclusions-Improvements in MSCT technology, combined with heart rate control, allow reliable noninvasive detection of obstructive coronary artery disease.