Patterns of coronary arterial lesion calcification by a novel, cross-sectional CT angiographic assessment.
Patterns of coronary arterial lesion calcification by a novel, cross-sectional CT angiographic assessment.
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DOI：
10.1007/s10554-013-0240-8
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发表时间：
2013-10
影响因子：
2.1
通讯作者：
Arbab-Zadeh, Armin
中科院分区：
文献类型：
--
作者：
Cerci, Rodrigo;Vavere, Andrea L.;Miller, Julie M.;Yoneyama, Kihei;Rochitte, Carlos E.;Dewey, Marc;Niinuma, Hiroyuki;Clouse, Melvin E.;Laham, Roger;Bush, David E.;Shapiro, Edward P.;Lardo, Albert C.;Cox, Christopher;Brinker, Jeffrey;Lima, Joao A. C.;Arbab-Zadeh, Armin
探讨冠状动脉病变钙化的CT血管造影（CTA）模式和诊断意义，采用一种新的横断面分级方法。在CorE-64研究中，371例患者接受了CTA和有创血管造影，通过定量冠状动脉造影（QCA）检测冠状动脉狭窄。在4,511个动脉段中，≥30%和≥50%病变的横断面上涉及钙的象限数通过CTA评估：非钙化，轻度（一象限），中度（二象限），严重（三象限）和非常严重（四象限钙）。受试者工作特征曲线下面积（AUC）用于评估CTA诊断斑块类型的准确性和一致性。在QCA治疗的≥50%的血管狭窄中，只有4%的血管非常严重钙化，而43%的血管没有钙化。非钙化斑块、轻度钙化斑块、中度钙化斑块、重度钙化斑块、极重度钙化斑块CTA检测≥50%狭窄的AUC分别为0.90、0.88、0.83、0.76、0.89 （p< 0.05）。在198个严重钙化的病变中，CTA存在或不存在可见残留管腔与QCA狭窄≥50%相关的比例分别为20.3%和76.9%。评价斑块钙化的观察者间变异性Kappa为0.93。单个冠状动脉病变的钙化可以用CTA可靠地分级。大多数≥50%的冠状动脉狭窄不是或只是轻度钙化。如果在CTA上没有看到残留的管腔，钙化病变预示着≥50%的狭窄，反之亦然。在钙化程度超过轻度的病变中，由于特异性较低，CTA检测≥50%狭窄的诊断准确性降低。
To investigate the patterns and diagnostic implications of coronary arterial lesion calcification by CT angiography (CTA) using a novel, cross-sectional grading method. For the CorE-64 study, 371 patients underwent CTA and invasive angiography for detecting coronary artery stenoses by quantitative coronary angiography (QCA). The number of quadrants involving calcium on a cross-sectional view for ≥30% and ≥50% lesions in 4,511 arterial segments was assessed by CTA according to: noncalcified, mild (one-quadrant), moderate (two-quadrant), severe (three-quadrant) and very severe (four-quadrant calcium). Area under the receiver operating characteristic curve (AUC) were used to evaluate CTA diagnostic accuracy and agreement vs. QCA for plaque types. Only 4% of ≥50% stenoses by QCA were very severely calcified while 43% were noncalcified. AUC for CTA to detect ≥50% stenoses by QCA for non-calcified, mildly, moderately, severely, and very severely calcified plaques were 0.90, 0.88, 0.83, 0.76 and 0.89, respectively (p< 0.05). In 198 lesions with severe calcification, the presence or absence of a visible residual lumen by CTA was associated with ≥50% stenosis by QCA in 20.3% and 76.9%, respectively. Kappa was 0.93 for interobserver variability in evaluating plaque calcification. Calcification of individual coronary artery lesions can be reliably graded using CTA. Most ≥50% coronary artery stenoses are not or only mildly calcified. If no residual lumen is seen on CTA, calcified lesions are predictive of ≥50% stenoses and vice versa. CTA diagnostic accuracy for detecting ≥50% stenoses is reduced in lesions with more than mild calcification due to lower specificity.
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