Measurement of coronary artery bifurcation angles by multidetector computed tomography
Measurement of coronary artery bifurcation angles by multidetector computed tomography
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DOI：
10.1097/01.rli.0000239318.88270.9f
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发表时间：
2006-11-01
影响因子：
6.7
通讯作者：
Achenbach, Stephan
中科院分区：
文献类型：
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作者：
Pflederer, Tobias;Ludwig, Josef;Achenbach, Stephan
目的：在冠状动脉分叉处最佳支架展开需要关于主血管和侧分支之间角度的信息。我们评价了对比增强16层多排计算机断层扫描（MDCT）测量分叉角度的准确性和观察者间变异性，并与侵入性血管造影进行比较，并检查了4个主要冠状动脉分叉的平均角度。为了确定MDCT测量分叉角度的准确性，我们使用MDCT扫描了包含6个分叉（角度在25度和90度之间的2-mm金属棒）的冠状动脉体模，并且将MDCT数据集中确定的角度与真实值进行比较。为了评估与侵入性血管造影相比角度测量的观察者间变异性，（左前降支和左回旋支冠状动脉[LAD/LCX]，LAD和第一对角分支[LAD/Diag I]，15例患者均行冠状动脉后降支和右后外侧分支[PDA/Rpld]检查，探测器行MDCT数据集和侵入性冠状动脉血管造影片，各由2名独立观察员进行。评估4个主要冠状动脉分叉角度的自然分布（LAD和LCX，LAD和Diag 1，LCX和OM I，PDA和Rpld），这些分叉的平均角度在16层MDCT数据集中确定，这些数据集是在一组100名连续的疑似冠状动脉疾病患者中采集的，用于冠状动脉可视化。体模研究显示测量角度和真实角度之间的平均差异为0.7 +/- 0.5度。在MDCT与侵入性血管造影的比较中，MDCT的45个角度明显更大（平均值：66 +/- 20度vs. 56 +/- 24度，P = 0.027）。MDCT的观察者间变异性（r = 0.91）显著低于有创血管造影（r = 0.62）。通过MDCT分析分叉角度的自然分布，显示平均值为80 +/- 27度（LAD/LCX），46 +/- 19度（LAD/LCX），（LAD/Diag 1）、48 +/- 24度（LCX/OM 1）和53 +/- 27度（PDA/Rpld）。MDCT可以高精度地评估冠状动脉分叉角度，这可能是未来规划介入治疗的潜力。
Objective: Optimal stent deployment in coronary artery bifurcations requires information about the angle between main vessel and side branch. We evaluated the accuracy and interobserver variability of bifurcation angle measurements by contrast-enhanced 16-slice multidetector computed tomography (MDCT) in comparison with invasive angiography and examined the average angles of 4 main coronary bifurcations.Methods: To determine the accuracy of MDCT for measurement of bifurcation angles, we scanned a coronary artery phantom containing 6 bifurcations (2-mm metal rods with angles between 25 degrees and 90 degrees) using MDCT, and angles determined in the MDCT data set were compared with the true values. To assess interobserver variability of angle measurements in comparison to invasive angiography, the angles of 3 bifurcation sites (left anterior descending and left circumflex coronary artery [LAD/LCX], LAD and first diagonal branch [LAD/Diag I], and posterior descending coronary artery and right posterolateral branch [PDA/Rpld]) were determined in 15 patients both in 16-detector row MDCT data sets and invasive coronary angiograms by 2 independent observers each. To assess the natural distribution of the 4 main coronary artery bifurcation angles (LAD and LCX, LAD and Diag 1, LCX and OM I, PDA and Rpld), the average angles of these bifurcations were determined in 16-slice MDCT data sets acquired for coronary artery visalization in a group of 100 consecutive patients with suspected coronary artery disease.Results: The phantom study revealed a mean difference between measured and true angles of 0.7 +/- 0.5 degrees. In the comparison MDCT versus invasive angiography, the 45 angles were significantly lager in MDCT (mean: 66 +/- 20 degrees vs. 56 +/- 24 degrees, P = 0.027). Interobserver variability was significantly lower in MDCT (r = 0.91) than invasive angiography (r = 0.62). Analysis of the natural distribution of bifurcation angles by MDCT revealed average values of 80 +/- 27 degrees (LAD/LCX), 46 +/- 19 degrees (LAD/Diag1), 48 +/- 24 degrees (LCX/OM1), and 53 +/- 27 degrees (PDA/Rpld), respectively.Conclusion: MDCT allows assessment of coronary bifurcation angles with high accuracy, which may be of future potential for planning interventional treatment.