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Quantifizierung von Stenosen der Koronararterien

64-Zeilen-CT-Angiographie und Dual Source vs. Herzkatheter

Quantification of coronary artery stenoses

Comparison of 64-slice and dual source CT angiography with cardiac catheterization

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Zusammenfassung

Hintergrund

Bisher erfolgte die Analyse von Koronarstenosen visuell mit der CT-Angiographie. Dadurch waren die Ergebnisse in hohem Maße von subjektiven Faktoren abhängig. Neue semiquantitative softwareunterstützte Methoden (CT-QCA, „quantitative coronary assessment“) erscheinen geeignet, um die diagnostische Genauigkeit und Reproduzierbarkeit der Ergebnisse verbessern.

Material und Methodik

Zwanzig Patienten wurden an einem 64-zeiligen Computertomographen (64-SCT, n= 10) oder Dual-source-CT (DSCT, n= 10, Somatom Sensation 64 und Somatom Definition, Siemens, Forchheim) untersucht. Zwei Radiologen bewerteten die Daten unabhängig voneinander visuell und mit Hilfe eines Softwaretools (Syngo Circulation, Siemens, Forchheim). Als Referenz diente die invasive Katheterangiographie (QCA). Ermittelt wurden die Sensitivität und Spezifität sowie der Korrelationskoeffizient, der systematische Fehler und die Interobserver-Übereinstimmung (Kappa).

Ergebnisse

In beiden Patientenkollektiven wurden jeweils 12 Stenosen festgestellt. Im Vergleich zum Herzkatheter betrugen Sensitivität und Spezifität für die Detektion von Stenosen >75% am 64-SCT bei der visuellen Auswertung 100 und 90%, bei der softwaregestützen Auswertung jeweils 100%. Beim DSCT lagen Sensitivität und Spezifität der visuellen und semiautomatischen Auswertung bei jeweils 100%. Der Bland-Altman-Plot der Ergebnisse des 64-SCT ergab im Vergleich zum Herzkatheter eine Überschätzung der Stenosen von durchschnittlich 3,3% (+/−62,7%/56,2%). Die Ergebnisse des DSCT zeigten eine Überschätzung durchschnittlich von 6,2% (+/−33,1%/19,8%). Die Interobserver-Übereinstimmung zwischen CT-QCA und visueller Beurteilung des 64-SCT erreichte einen Kappa-Wert von 0,75, die des DSCT einen Wert von 1,0.

Schlussfolgerung

Die Ergebnisse zeigen eine gute Übereinstimmung der softwaregestützen CT-QCA mit den Ergebnissen des Herzkatheters. Die Ergebnisse des DSCT sind aufgrund der höheren zeitlichen Auflösung im Vergleich zu denen des 64-SCT viel versprechend, müssen jedoch anhand eines größeren Patientenkollektivs bestätigt werden.

Abstract

Background

Until now stenoses of the coronary arteries have been evaluated visually with CT angiography. Therefore, the results were highly dependent on subjective factors inherent in the examiner. New software tools for semiquantitative analysis (CT-QCA, quantitative coronary assessment) might be adequate to improve the diagnostic accuracy und reproducibility.

Material and methods

CTAs of 20 patients were analyzed. Ten patients each were evaluated using 64-slice CT (64SCT) and dual source CT (DSCT) (Somatom Sensation 64 and Somatom Definition, Siemens Medical Solutions, Forchheim), respectively. Two radiologists independently evaluated the data visually and with the help of a software tool (Syngo Circulation, Siemens Medical Solutions, Forchheim). The results of the quantitative assessment of the invasive heart catheterization served as the reference standard. Sensitivity and specificity as well as the correlation coefficient, the systematic error, and the interobserver agreement (kappa) were determined.

Results

In each of both patient groups 12 stenoses were detected. For the detection of stenoses >75%, sensitivity and specificity for the visual evaluation using the 64SCT were 100% and 90%, and with the CT-QCA both were 100%. For the DSCT sensitivity and specificity were 100% for both the visual and semiautomated evaluation. The Bland-Altman plot of the results of the 64SCT showed an overestimation of 3.3% (±62.7%/56.2%) compared to the heart catheterization. The results of the DSCT exhibited an overestimation of 6.2% (±33.1%/19.8%). The interobserver agreement of the CT-QCA and the visual evaluation showed a kappa value of 0.75 and for DSCT of 1.0.

Conclusion

The results showed a good correlation of grading stenosis between the software-assisted evaluation and the results of the coronary catheter angiography. The promising results of the DSCT are due to a superior temporal resolution compared to the 64SCT. Confirmation of these data by trials in larger patient collectives is warranted.

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Authors and Affiliations

  1. Institut für Klinische Radiologie, Klinikum Großhadern der Ludwig-Maximilians-Universität München , Marchioninistr. 15, 81377, München, Deutschland

    Stephanie Busch, K. Nikolaou, T. Johnson, C. Rist, A. Knez, M. Reiser & C. Becker

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  1. Stephanie Busch
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  2. K. Nikolaou
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  3. T. Johnson
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  4. C. Rist
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  5. A. Knez
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  6. M. Reiser
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  7. C. Becker
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Correspondence to Stephanie Busch.

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Busch, S., Nikolaou, K., Johnson, T. et al. Quantifizierung von Stenosen der Koronararterien. Radiologe 47, 295–300 (2007). https://doi.org/10.1007/s00117-007-1476-x

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  • DOI: https://doi.org/10.1007/s00117-007-1476-x

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