The Diagnostic Value Of Multislice Computed Tomography In Left Main Coronary Artery Disease

Objective The aim of this study is to investigate the advantage of Multislice Computed Tomography(MSCT) in the diagnosis of left main(LM) coronary artery disease,to evaluate the accuracy of MSCT in both the quantification analysis of the LM lesion and the determination of the characteristics of the plaques in LM.M1ethods A total of 91 patients(53 male,38 female,mean age 64.78±9.19yrs) were examined by MSCT,CAG and IVUS.Compared with the IVUS,the sensitivity, specificity,positive(PPV) and negative predictive values(NPV) of the MSCT on the diagnosis of LM diseases were calculated.Also,kappa index(κ) for the agreement between MSCT,CAG and IVUS was calculated.MLA,EEM-CSA, plaque burden were manually traced by 2 blinded and independent operators on MSCT cross-sectional reconstruction and compared with IVUS.The CT value of soft,fibrostic and calcific plaques was measured using IVUS classification of the plaques.Results The sensitivity,specificity,positive(PPV) and negative predictive values (NPV) of CAG for detecting plaques at LM were 25.0%,100.0%,100.0%,26.0%, respectively.Kappa index was 0.122(P＜0.05).The sensitivity,specificity,positive (PPV) and negative predictive values(NPV) of MSCT for detecting LM plaques were 93.1%,84.2%,95.7%,76.2%,respectively.Also,kappa index(κ=0.744,P＜0.001) indicated excellent agreement.The correlation between minimal lumen area(MLA) on IVUS and MLA on MSCT was significant(r=0.815,P＜0.01).The correlation between IVUS plaque burden and computed tomographic plaque burden was moderate(r=0.736,P＜0.01).CT value of soft plaques,fibrostic plaques and calcific plaques was 50.77±17.88HU(12.6-94.2HU),114.89+ 47.75HU(24-276.9HU) and 645.30±377.08HU(60.2-1557.9HU),P＜0.001. Receiver operating characteristic curve analysis of CT density of noncalcific plaques for predicting soft plaques show the cutpoint is 64.8HU,with a sensitivity of 88.9%and specificity of 87.4%.Conclusions Sixty-four section MSCT is an effective diagnostic tool for the detection of left main coronary artery plaques.The correlation of quantitive analysis between MSCT and IVUS is excellent.The CT value of plaques can help diagnosis of plaque composition.