Diagnostic performance of coronary CT angiography to diagnose acute spontaneous coronary artery dissection

作者：Lukas J. Moser, Tristan T. Demmert, Konstantin Klambauer, Victor Schweiger, Victor Mergen, Michael Würdinger, Davide Di Vece, Andrea Biondo, Alexander Gotschy, Barbara E. Stähli, Martin Reiner, Jelena-R. Ghadri, Robert Manka, Matthias Eberhard, Christian Templin, Hatem Alkadhi · 发表于：Journal of cardiovascular computed tomography · 年份：2025 · DOI：10.1016/j.jcct.2025.09.002 · 被引用次数：4 · 研究领域：Cardiovascular Issues in Pregnancy、Cardiac Imaging and Diagnostics、Aortic Disease and Treatment Approaches

BACKGROUND: The diagnosis of spontaneous coronary artery dissection (SCAD) is made with invasive coronary angiography (ICA). The literature on the diagnostic performance of coronary CT angiography (coronary CTA) is sparse. The purpose of this study was to evaluate the performance of coronary CTA for the diagnosis of acute SCAD. METHODS: This prospective single-center study included 52 patients with SCAD confirmed by ICA and 70 patients with chest pain but without SCAD (control group), who all underwent coronary CTA. Two independent readers evaluated coronary CTA for SCAD, including vessel abnormalities and myocardial hypodensity. Accuracy, sensitivity, and specificity with 95 % confidence intervals (CI) were calculated using ICA as the reference standard. Coronary CTA imaging features of SCAD were correlated with diagnostic confidence using multivariable regression analysis. Interreader agreement was determined by Cohen's Kappa. RESULTS: Patient-level sensitivity of coronary CTA to diagnose SCAD ranged from 52 % (CI:38 %-66 %)-58 % (CI:43 %-71 %), with a specificity of 97 % (CI:90 %-100 %) and accuracy of 78 % (CI:69 %-85 %) and 80 % (CI:72 %-87 %) for both readers (Kappa = 0.891). Sensitivity and accuracy were higher for proximal (sensitivity 67 % (CI:38 %-88 %) and 73 % (CI:45 %-92 %); accuracy 93 % (CI:87 %-97 %) and 94 % (CI:89 %-98 %)) than for distal SCAD (sensitivity 40 % (CI:26 %-56 %) and 49 % (CI:34 %-64 %); accuracy 76 % (CI:68 %-83 %) and 80 % (CI:71 %-86 %)), whi...