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目的在筛查冠状动脉钙化(CAC)和肺癌的同时,论证低剂量CT(LDCT)对可视化冠状动脉钙化评分(VCACS)的可靠性。方法我们收集了401例受试者,均接受低剂量CT进行肺癌筛查和ECG-门控的冠状动脉钙化评分(AS)。分别应用3mm和5mm层厚对LDCT进行重建,以获取3mm的VCACS和5mm的VCACS。32例应用于预评估阶段,其余369例受试者由2名观察者独立完成4个等级VCACS(无、轻度、中度、重度)的分类,并将结果同AS的4个等级进行比较(0,1～100,101～400,>400)。结果受试者CAC的检出率为39.6%(146/369)。3mm重组的VCACS敏感度高于5mm重组的VCACS(83.6%∶74.0%)。24例3mm重组的VCACS的AS假阴性中位数为2.3(范围1.1～21.1),假阴性的发生率为1.9%。与5mm重组的VCACS相比,3mm重组的VCACS与AS具有更高的一致性。在进一步的实验中,4名初级观察者对3mm重组的VCACS的评估,显示了观察者间高度的可靠性以及同AS较好的一致性(κ=0.662～0.747)。结论本研究论证了LDCT肺癌筛查中的VCACS可靠性,同时显示在冠状动脉疾病危险分层方面LDCT 3mm较LDCT 5mm更具可行性。要点①LDCT很少漏掉显著的CAC。②LDCT的可视化CAC评分同Agatston评分具有高度的一致性。③在分析冠心病危险分层方面LDCT 3mm较LDCT5mm更具有可行性。④CAC评估丰富了LDCT肺癌筛查的信息。
Objective To screen the reliability of visualization of coronary artery calcification score (VCACS) with low-dose CT (LDCT) while screening for coronary artery calcification (CAC) and lung cancer. Methods We collected 401 subjects who underwent low-dose CT for lung cancer screening and ECG-gated coronary artery calcification score (AS). The LDCT was reconstructed using 3 mm and 5 mm layer thickness, respectively, to obtain a 3 mm VCACS and a 5 mm VCACS. 32 cases were used in the pre-assessment stage, and the remaining 369 subjects were independently classified into 4 levels of VCACS (no, mild, moderate, severe) by 2 observers and the results were compared with 4 levels of AS (0,1 ~ 100,101 ~ 400,> 400). Results The detection rate of CAC in subjects was 39.6% (146/369). The VCACS sensitivity of 3 mm recombinant was higher than that of 5mm recombinant VCACS (83.6%: 74.0%). The median false-negative AS of 24 3-mm-reassembled VCACS patients was 2.3 (range, 1.1 to 21.1), with a false-negative incidence of 1.9%. The 3-mm reassembled VCACS is more consistent with the AS than the 5mm-reassembled VCACS. In a further experiment, the assessment of 3 mm-reassembled VCACS by 4 primary observers showed a high degree of reliability among observers and a good agreement with AS (κ = 0.662-0.747). Conclusions This study demonstrates the reliability of VCACS in LDCT lung cancer screening and at the same time shows that LDCT 3 mm is more feasible than LDCT 5 mm in the risk stratification of coronary artery disease. Points ①LDCT rarely sequesters significant CAC. ② visualization of LDCT CAC score with Agatston score highly consistent. ③ In the analysis of risk stratification of coronary heart disease LDCT 3mm LDCT5mm more feasible. ④ CAC assessment enriched LDCT lung cancer screening information.