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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.

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참고문헌 (26건) : 자료제공( 네이버학술정보 )

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번호 참고문헌 국회도서관 소장유무
1 Klocke FJ, Baird MG, Lorell BH, Bateman TM, Messer JV, Berman DS, et al. ACC/AHA/ASNC guidelines for the clinical use of cardiac radionuclide imaging: executive summary - a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (ACC/ AHA/ASNC Committee to Revise the 1995 Guidelines for the Clinical Use of Cardiac Radionuclide Imaging). J Am Coll Cardiol 2003;42:1318-1333 미소장
2 Our Preoccupation With Coronary Luminology 네이버 미소장
3 White CW, Wright CB, Doty DB, Hiratza LF, Eastham CL, Harrison DG, et al. Does visual interpretation of the coronary arteriogram predict the physiologic importance of a coronary stenosis? N Engl J Med 1984;310:819-824 미소장
4 Quantification of obstructive and nonobstructive coronary lesions by 64-slice computed tomography: a comparative study with quantitative coronary angiography and intravascular ultrasound. 네이버 미소장
5 Ropers D, Rixe J, Anders K, Ku ¨ttener A, Baum U, Bautz W, et al. Usefulness of multidetector row spiral computed tomography with 64- × 0.6-mm collimation and 330-ms rotation for the noninvasive detection of significant coronary artery stenoses. Am J Cardiol 2006;97:343-348 미소장
6 Accuracy of multidetector spiral computed tomography in identifying and differentiating the composition of coronary atherosclerotic plaques: a comparative study with intracoronary ultrasound. 네이버 미소장
7 Relationship Between Noninvasive Coronary Angiography With Multi-Slice Computed Tomography and Myocardial Perfusion Imaging 네이버 미소장
8 Sixty-four slice spiral CT angiography does not predict the functional relevance of coronary artery stenoses in patients with stable angina. 네이버 미소장
9 Functionally relevant coronary artery disease: comparison of 64-section CT angiography with myocardial perfusion SPECT. 네이버 미소장
10 A pretest prognostic score to assess patients undergoing exercise or pharmacological stress testing. 네이버 미소장
11 Patient dose in cardiac computed tomography. 네이버 미소장
12 Coronary artery stenosis quantification using multislice computed tomography. 네이버 미소장
13 Cordeiro MA, Lardo AC, Brito MS, Neto MA, Siqueira MH, Parga JR, et al. CT angiography in highly calcified arteries: 2D manual vs. modified automated 3D approach to identify coronary stenoses. Int J Cardiovasc Imaging 2006;22:507-516 미소장
14 Diagnostic accuracy of dual-source multi-slice CT-coronary angiography in patients with an intermediate pretest likelihood for coronary artery disease 네이버 미소장
15 Standardized myocardial segmentation and nomenclature for tomographic imaging of the heart. A statement for healthcare professionals from the Cardiac Imaging Committee of the Council on Clinical Cardiology of the American Heart Association. 네이버 미소장
16 A Reporting System on Patients Evaluated for Coronary Artery Disease 네이버 미소장
17 Effect of Heart Rate and Coronary Calcification on the Diagnostic Accuracy of the Dual-Source CT Coronary Angiography in Patients with Suspected Coronary Artery Disease 소장
18 Diagnostic Tests 2: Predictive Values 네이버 미소장
19 Assessment of the relationship between stenosis severity and distribution of coronary artery stenoses on multislice computed tomographic angiography and myocardial ischemia detected by single photon emission computed tomography. 네이버 미소장
20 Gaemperli O, Schepis T, Koepfli P, Valenta I, Soyka J, Leschka S, et al. Accuracy of 64-slice CT angiography for the detection of functionally relevant coronary stenoses as assessed with myocardial perfusion SPECT. Eur J Nucl Med Mol Imaging 2007;34:1162-1171 미소장
21 Nicol ED, Schultz C, Stirrup J, Roughton M, Padley SP, Rubens MB, et al. Defining the appropriate CTA stenosis threshold for gatekeeping to invasive angiography: 50% or 70%? Int J Cardiol 2010;144:297-298 미소장
22 Gaemperli O, Husmann L, Schepis T, Koepfli P, Valenta I, Jenni W, et al. Coronary CT angiography and myocardial perfusion imaging to detect flow-limiting stenoses: a potential gatekeeper for coronary revascularization? Eur Heart J 2009;30:2921-2929 미소장
23 Incremental value of adenosine-induced stress myocardial perfusion imaging with dual-source CT at cardiac CT angiography. 네이버 미소장
24 Combined functional and morphological imaging consisting of gated myocardial perfusion SPECT and 16-detector multislice spiral CT angiography in the noninvasive evaluation of coronary artery disease: first experiences 네이버 미소장
25 Prevalence of Noncalcified Coronary Plaques by 64-Slice Computed Tomography in Patients With an Intermediate Risk for Significant Coronary Artery Disease 네이버 미소장
26 Comparison of stress perfusion MRI and SPECT for detection of myocardial ischemia in patients with angiographically proven three-vessel coronary artery disease. 네이버 미소장

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