Diagnostic Accuracy Of Multi-slice Coronary CT And Its Significance For Risk Stratification Of Coronary Artery Disease

Objective To evaluate the accuracy of multi-slice coronary CT to diagnose coronary disease and the characterization of atherosclerosis plaque,and to test the possibility of using MSCT for recognizing the vulnerable plaque and risk stratification of coronary diseases.Methods Part one:Patients with known coronary heart diseases underwent MSCT,QCA and IVUS within one week from August of 2007 to December of 2008 were included in this study.V-CSA,L-CSA,stenosis degree and plaque burden of the same section located in the same lesion were tested with three above different methods.Sensitivity,specificity,PPV and NPV of MSCT to diagnose coronary heart diseases and evaluate the characterization of plaque against QCA and IVUS were calcuated.Part two:Patients diagnosed with acute coronary syndrome(ACS) or stable angina pectoris(SAP) underwent MSCT before percutaneous coronary interventions in 72hours from August of 2007 to February of 2009 were included in this study.Lesions in ACS were divided into culprit and non-culprit ones on the basis of the association of angiographic lesion appearance with ECG and myocardial ischemia as detected during stress testing.Lesions in SAP were classified as stable ones.Further,the characterizations of three different lesions were compared based on MSCT.The relationship between clinical diagnosis and plaque types were also been analyzed.Results Part one:1.Compared with IVUS,sensitivity,specificity,PPV, and NPV of MSCT for detecting plaque is 98%,90.1%,93%,and 97%, respectively.The corresponding index compared with QCA is 98%,92.8%,95.2%, and 97%,respectively.2.Compared with IVUS,sensitivity,specificity,PPV,and NPV of MSCT for detecting stenosis degree more than 50%is 96.5%,97.1%,98.2%,and 94.3%, respectively.The corresponding index compared with QCA is 98.2%,94.4%, 96.5%,and 97.1%,respectively.3.V-CSA,L-CSA,BP and RI tested by MSCT and IVUS in the same section located in the same plaque are rectilinear correlated significantly.4.Sensitivity,specificity of MSCT for recognizing lipid plaque is 88.9%, 84.9%,respectively.For fibrosis plaque,that is 73.3%,91.2%.For calcified plaque,that is 95.7%,100%.Hounsfield value of lipid,fibrosis and calcified plaque is 45±26Hu,81±29Hu,561±226Hu,respectively.Part two:1.Plaque characterization of culprit lesions,non-culprit ones,and stable one are statistic difference significantly(P＜0.05).For culprit lesions in ACS, non-calcified plaques are major.But for another two groups,the distribution of three kinds of plaque is no statistic significance.The proportion of non-calcified plaques in three groups is statistically significant.For culprit lesion,lipid plaque is major,but for another two groups,fibrosis plaque is major.2.The stenosis degree and L-CSA are no statistical significance but V-CSA, PB,RI and EI are statistical significance.Further studies showed:the proportion of positive remolding and eccentric plaque in culprit lesions of ACS are significantly more than another groups.3.Coronary lesions of different clinical diagnosis are significant difference. For STEMI patients,discrete lesion is major.For NSTEMI patients,diffuse lesion is major.Conclusions Compared with IVUS and QCA,MSCT is very accurate to diagnose coronary artery diseases,evaluate the characterization of atherosclerosis plaques.It can be as a noninvasive tool to detect vulnerable plaque and stratify coronary risk according to different coronary plaque.