- 作者：Edward D. Nicol ; James Stirrup ; Eliana Reyes ; Michael Roughton ; Simon P.G. Padley ; Michael B. Rubens ; S. Richard Underwood
- 关键词：Computed tomography ; myocardial perfusion scintigraphy ; coronary angiography ; coronary artery disease
- 刊名：Journal of Nuclear Cardiology
- 出版年：2008
- 出版时间：May-June 2008
- 年：2008
- 卷：15
- 期：3
- 页码：311-318
- 全文大小：429 K
ass=""h4"">Background
Multislice computed tomography coronary angiography (CTA) was proposed as a method for investigating possible coronary artery disease (CAD) in patients who present with chest pain but with a low to intermediate likelihood of CAD. Sixty-four-channel CTA was compared prospectively with 99mTc-tetrofosmin myocardial perfusion scintigraphy (MPS) (as the gold standard in the detection of flow-limiting stenoses) for the detection of functionally significant CAD.ass=""h4"">Methods and Results
Fifty-two consecutive symptomatic patients with a low to intermediate likelihood of coronary artery disease, and who were referred for MPS, also underwent CTA. The CTA datasets were analyzed by two experienced observers who were blinded to the MPS data, and coronary artery segments were reported as < 50 % , 50 % to 69 % , 70 % to 99 % stenoses, or occluded. The MPS images were similarly analyzed for inducible perfusion abnormalities, and coronary territories were identified. At the patient level, agreement between CTA and MPS for CTA lesions at ≥ 50 % was 87 % (sensitivity, 100 % ; specificity, 84 % ; positive predictive value, 50 % ; negative predictive value, 100 % ). For CTA lesions, agreement at ≥ 70 % was 96 % (sensitivity, 86 % ; specificity, 98 % ; positive predictive value, 86 % ; negative predictive value, 98 % ).
ass=""h4"">Conclusions
In patients with a low to intermediate likelihood of CAD, there is good correlation between MPS and CTA for the detection of functionally significant coronary artery stenoses when CTA detects a narrowing of ≥ 70 % severity. Computed tomography coronary angiography stenoses of 70 % should be used to determine functional significance, and not 50 % , as is the usual practice at present.