40-slice Multi-detector Computed Tomography in Detecting Coronary Artery Stenosis: A Preliminary Result

40切多層次電腦斷層偵測冠狀動脈狹窄的初步結果

陳志程(Jyh-Ching Chen) ； 王明宗(Min-Tsung Wang) ； 王怡誠(Yi-Chen Wang) ； 陳俊彰(Chun-Chang Chen) ； 蔡仁明(Jen-Ming Tsai) ； 張永源(Yong-Yuan Chang) ； 林燕亭(Yen-Ting Lin)

《中華放射線醫學雜誌》 34卷3期 (2009/09) Pp. 161-171

摘要

本研究的目地的是為了評估疑似冠心症病患使用40切多層次電腦斷層偵測冠狀動脈狹窄的準確度。
我們總共收集19位臨床上有心絞痛表現的病患（包含15位男性及4位女性），平均年齡為64.1歲，他們接受多層次電腦斷層檢查，並且用傳統血管攝影作為比較的標準。其中有二位病患因心律不整造成影像無法判讀而排除在我們的研究行列。我們統計分析每個段落的靈敏度、專一性、精準度、正預測值及負預測值。
多層次電腦斷層偵測到冠狀動脈明顯狹窄的段落，得到的結果與傳統血管攝影相對照發現，靈敏度為97%，專一性為98%，精準度為98%，正預測值為86%，及負預測值為99%。
由此可見，使用40切多層次電腦斷層，可提供冠狀動脈狹窄的病人具有可信賴性的非侵入性診斷。

並列摘要

Our purpose was to demonstrate the diagnostic accuracy of 40-slice multi-detector computed tomography for detecting significant coronary stenosis in patients with suspected coronary arterial disease.
Between Jan. 2007 and Dec. 2007, 19 consecutive patients with suspected coronary arterial disease were scheduled for computed tomography coronary angiography. Among them, there were 15 male and 4 female. The average age was 64.1 years (range, 32-88 years). Two out of 19 patients with poor image quality due to cardiac dysrhythmia were excluded from our study. They underwent conventional coronary angiography followed by the computed tomography coronary angiography 1-3 days later (mean interval time, 1.5 days). The sensitivity, specificity, diagnostic accuracy, positive predictive value and negative predictive value of 40-slice multi-detector computed tomography in the detection of coronary stenosis were evaluated on the basis of per segment.
Computed tomography coronary angiography depicted 39 segments with significant stenosis. Overall, the sensitivity was 97% and the specificity 98%. The accuracy was 98%, the negative predictive value was 99%, and the positive predictive value was 86%. Our 40-slice MDCT overestimated 7 stenoses and underestimated 1 significant stenoses. Among these overestimated lesions, they were either due to motion artifacts or calcified plaques. Furthermore, the underestimated lesion over left main coronary artery was due to under-calculation.
Our preliminary results suggest that 40-slice multi-detector computed tomography is useful in diagnosis of coronary arterial stenosis, which permits a non-invasive assessment of significant coronary arterial disease with a high diagnostic accuracy.