고식적인 관상동맥 조영술과 MDCT를 이용한 관상동맥조영술의 비교

초록

Purpose : Given the high costs and invasiveness of coronary angiography, there is increased interest in noninvasive coronary angiography. The purpose of this study was to evaluate the technique of coronary angiography with retrospectively electrocardiogram (ECG)-gated 16-slice multidetector row computed tomography (MDCT) Materials and Methods : Within one month of undergoing routine day-case diagnostic coronary angiography, 33 consecutive patients also underwent multidetector row CT coronary angiography (16X0.75-mm collimation, feed/rotation of 3,370-msec gantry rotation time, retrospective electrocardiographic gating, 1-mm efective section thickness. This enabled direct comparison of all main coronary arteries with side branches including acute marginal, posterolateral, diagonal, or obtuse marginal branches for each patient by two blinded assessors. Each segment of coronary artery from the CT image was evaluated initially for assessability and those segments deemed assessable were subsequently investigated for the presence of absence of a significantly (n=50%) stenotic lesion. Results : Total of 635 segments was shown in conventional angiography and 529 segments (84%) of all main coronary arteries with side branches were assessable. The sensitivity and specificity of 16-slice CT coronary angiography in assessable segments for detecting the presence or absence (n=50%) of stenosses were 62% and 95%, respectively. These results correspond to a positive predictive value of 57%, a negative predictive value of 96% and an accuraty of 92%. Conclusion : Although multidetector row CT coronary angiography was more advanced to evaluate side branches of main coronary arteries., the overall assessability and diagnostic accuracy of 16-slice CT acquisition is not sufficient to justify routine clinical use. Further, evaluation should investigate the benefit of the reduction in temporal and spatial resolution offered by 64 or 128 slice acquisition.