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Evaluation of Agreement between 64-slice Computed Tomography Angiography and 201-Tl Single Photon Emission Computed Tomography-myocardial Perfusion Imaging in the Diagnosis of Significant Coronary Artery Disease

Other Title
의미 있는 관상동맥질환의 진단을 위한 64절편 관상동맥 CT조영술과 201-TI SPECT-심근관류영상의 일치도 평가
Authors
Ma, JH; Kang, DK; Lee, SJ; An, YS; Lim, HS
Citation
Taehan Yŏngsang Ŭihakhoe chi, 64(6):541-551, 2011
Journal Title
Taehan Yŏngsang Ŭihakhoe chi; Journal of the Korean Radiological Society; Journal of the Korean Society of Radiology; 대한영상의학회지
ISSN
1738-26372288-2928
Abstract
Purpose:To compare coronary computed tomography angiography (CTA) with single photon emission computed tomography-myocardial perfusion imaging (SPECT-MPI) for the detection of physiologically significant coronary artery disease (CAD).



Materials and Methods :We evaluated 202 patients undergoing 64-slice coronary CTA and 201-Tl SPECT-MPI within a 3-month time interval. In addition, 68 patients underwent invasive coronary angiography (ICA). Coronary artery stenoses with luminal narrowing ≥50% were defined as “significant” on CTA and ICA. All myocardial segments were classified as reversible or fixed perfusion defects and normal segments on 201-Tl SPECT-MPI, and were allocated to the corresponding coronary vessels. Agreement and diagnostic performance between each imaging modality for physiologically significant CAD was calculated using the kappa (κ) statistic and receiver operating characteristic analysis, respectively.



Results:The sensitivity and specificity of CTA for the detection of physiologically significant CAD were 88% and 86% by patient-based analysis, and 84% and 91% by vessel-based analysis as compared to 201-Tl SPECT-MPI, respectively. The agreement between CTA and SPECTMPI was good (κ= 0.647) and moderate (κ= 0.558) by patientand vessel-based analyses, respectively. The accuracy of CTA for predicting perfusion defects on SPECT-MPI was comparable (area under the curve; 0.814 vs. 0.819, p=0.902 on patient-based analysis, and 0.808 vs. 0.749, p=0.197 on vessel-based analysis) to ICA.



Conclusion:Coronary stenosis ≥50% on coronary CTA shows good agreement with perfusion defects in SPECT-MPI.

목적 :관류결손을 보이는 의미 있는 관상동맥질환을 발견하는 데 있어 관상동맥 CT 조영술을 심근관류영상과 비교하고자 하였다.



대상과 방법 :64-절편 CT 조영술 및 201-Tl SPECT-심근관류영상을 시행한 202명의 환자를 대상으로 하였다. 침습적 혈관조영술이 68명에서 추가로 시행되었다. 관상동맥의 직경이 50% 이상 감소한 경우 의미 있는 협착으로 간주하고, 심분절은 심근관류 정도에 따라 가역성, 비가역성 그리고 정상으로 분류하여 각 심분절을 해당 관상동맥과 비교하였다. 생리학적으로 의미 있는 협착을 진단하는 각 영상진단방법 사이의 일치도를 Kappa 통계를 이용하여 분석하고, receiver operating characteristic 분석으로 진단 정확도를 비교하였다.



결과 :CT 조영술의 민감도 및 특이도는 환자를 대상으로 각각 88%와 86%, 혈관을 대상으로 84%와 91%이었다. CT 조영술과 SPECT-심근관류영상 사이에 환자를 대상으로 좋은 일치도(κ= 0.647), 혈관을 대상으로 중등도(κ = 0.558)의 일치도를 보였다. CT 조영술의 진단 정확도는 침습적 혈관조영술과 대등하였다.



결론 :CT 조영술에서 직경 50% 이상의 협착은 심근관류영상의 관류결손 부위와 통계적으로 의미 있는 일치도를 보인다.
Keywords
TomographyX-Ray ComputedCoronary Artery DiseaseCoronary AngiographyMyocardial Perfusion Imaging
Appears in Collections:
Journal Papers > School of Medicine / Graduate School of Medicine > Nuclear Medicine & Molecular Imaging
Journal Papers > School of Medicine / Graduate School of Medicine > Cardiology
Journal Papers > School of Medicine / Graduate School of Medicine > Radiology
AJOU Authors
강, 두경이, 수진안, 영실임, 홍석
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