- 期刊
The Incremental Diagnostic Performance of Coronary Computed Tomography Angiography Added to Myocardial Perfusion Imaging in Patients with Intermediate-to-High Cardiovascular Risk
並列摘要
Purpose: Several studies have suggested that a combined approach of stress myocardial perfusion imaging (MPI) and coronary computed tomography angiography (CCTA) can provide diagnostic results with excellent accuracy. We aimed to explore whether the addition of CCTA to stress MPI provides incremental diagnostic value in intermediate-to-high cardiovascular risk patients. Methods: A total of 106 consecutive patients (93 male, 65 ± 10.4 years) underwent coronary artery calcium scoring (CACS), CCTA and ^(201)Thallium stress MPI before coronary angiography was reviewed. Thirty-seven patients (34.9%) had a history of proven coronary artery disease (CAD) or revascularization procedures, and four had documented non-significant CAD (3.8%). The remaining patients consisted of 17 (16.0%) classified as intermediate, and 48 (45.3%) as the high-risk groups. Results: Obstructive CAD was diagnosed by invasive coronary angiography in 88 patients with 161 vessels. The sensitivity and specificity in a patient-based analysis for obstructive CADwere 99% and 17% for CCTA, 80% and 50% for MPI and 91% and 67% for the combined method, respectively. The per-vessel diagnostic sensitivity and specificity were 95% and 54% for CCTA, 59% and 75% for MPI and 84% and 76% for the combined method. There were significant differences (p ＜ 0.05) when comparing the combined method with MPI or CCTA by areas under the curve in a patient- or vessel-based analysis. However, CACS of 400 or more could not further stratify the patients with obstructive CAD. Conclusions: CCTA, not CACS, provided additional diagnostic values to stress MPI in patients with intermediateto- high cardiovascular risk.
延伸閱讀
- 胡卉婕、方鶯珍、陳鴻毅（2018）。Clinical Experiences of Coronary Computed Tomography Angiography in Diagnosis of Coronary Artery Disease。北市醫學雜誌，15(3)，19-29。https://doi.org/10.6200/TCMJ.201809_15(3).0003
- Nagatomo, D., Yanagi, D., Serikawa, T., Okabe, M., & Yamamoto, Y. (2014). The Role of Intravascular Ultrasound Scan and Thin-Sliced Coronary Computed Tomography Angiography in Diagnosing Aortic Dissection Causing Acute Myocardial Infarction. International Journal of Case Reports and Images (IJCRI), 5(4), 302-306. https://doi.org/10.5348/ijcri-201462-CR-10373
- Chua, S. K., Hung, H. F., Cheng, J. J., Tseng, M. T., Law, W. Y., Kuo, C. J., Chiu, C. Z., Chang, C. M., Lee, S. H., Lo, H. M., Lin, S. C., Liou, J. Y., & Shyu, K. G. (2013). Diagnostic Performance of 64- versus 256-Slice Computed Tomography Coronary Angiography Compared with Conventional Coronary Angiography in Patients with Suspected Coronary Artery Disease. Acta Cardiologica Sinica, 29(2), 151-159. https://www.airitilibrary.com/Article/Detail?DocID=10116842-201303-201303290016-201303290016-151-159
- Huang, J. Y. (2016). Diagnostic Performance of Computed Tomography Attenuation Corrected Thallium-201 Myocardial Perfusion Imaging among Patients with Suspected Coronary Artery Disease [master's thesis, National Taiwan University]. Airiti Library. https://doi.org/10.6342/NTU201601449
- Hsieh, F. C., Lin, J. N., Tsai, T. C., Chou, C. K., Hsu, L. S., & Wei, M. C. (2011). Assessment of Radiation Dose and Image Quality in Coronary Computed Tomography Angiography Using Adaptive Statistical Iterative Reconstruction and a Body Mass Index-adapted Protocol. Journal of Radiological Science, 36(2), 2-7. https://doi.org/10.6698/JRS.201106_3602.01