대한영상의학회지 (Journal of the Korean Society of Radiology)

  • 제64권6호
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  • Pages.541-551
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  • 2011
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  • 1738-2637(pISSN)
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  • 2288-2928(eISSN)
대한영상의학회 (The Korean Society of Radiology)
권호 표지

의미 있는 관상동맥질환의 진단을 위한 64절편 관상동맥 CT조영술과 201-TI SPECT-심근관류영상의 일치도 평가

Evaluation of Agreement between 64-slice Computed Tomography Angiography and 201-Tl Single Photon Emission Computed Tomography-myocardial Perfusion Imaging in the Diagnosis of Significant Coronary Artery Disease

  • 마지현 (아주대학교 의과대학 영상의학교실) ;
  • 강두경 (아주대학교 의과대학 영상의학교실) ;
  • 이수진 (아주대학교 의과대학 핵의학과학교실) ;
  • 안영실 (아주대학교 의과대학 핵의학과학교실) ;
  • 임홍석 (아주대학교 의과대학 순환기내과학교실)
  • Ma, Jee-Hyun (Department of Radiology, Ajou University School of Medicine) ;
  • Kang, Doo-Kyoung (Department of Radiology, Ajou University School of Medicine) ;
  • Lee, Su-Jin (Department of Nuclear Medicine, Ajou University School of Medicine) ;
  • An, Young-Sil (Department of Nuclear Medicine, Ajou University School of Medicine) ;
  • Lim, Hong-Seok (Department of Cardiology, Ajou University School of Medicine)
  • 발행 : 2011.06.01
⟨ 이전 논문 다음 논문 ⟩

초록

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($\kappa$= 0.647), 혈관을 대상으로 중등도($\kappa$= 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.

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 ${\geq}$50% were defined as "significant" on CTA and ICA. All myocardial segments were classified as reversible or fixed perfusion defects and normal segments on 201-Tl SPECT-MPI, and were allocated to the corresponding coronary vessels. Agreement and diagnostic performance between each imaging modality for physiologically significant CAD was calculated using the kappa ($\kappa$) statistic and receiver operating characteristic analysis, respectively. Results: The sensitivity and specificity of CTA for the detection of physiologically significant CAD were 88% and 86% by patient-based analysis, and 84% and 91% by vessel- based analysis as compared to 201-Tl SPECT-MPI, respectively. The agreement between CTA and SPECTMPI was good ($\kappa$= 0.647) and moderate ($\kappa$= 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 ${\geq}$50% on coronary CTA shows good agreement with perfusion defects in SPECT-MPI.

키워드

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