Bauer Ralf W, Thilo Christian, Chiaramida Salvatore A, Vogl Thomas J, Costello Philip, Schoepf U Joseph
Department of Radiology and Radiological Science, Medical University of South Carolina, Ashley River Tower, 25 Courtenay Dr., MSC 226, Charleston, SC 29401, USA.
AJR Am J Roentgenol. 2009 Aug;193(2):410-8. doi: 10.2214/AJR.08.1277.
The purpose of this study was to examine the relation between the coronary CT angiographic findings of calcified and noncalcified plaque burden and stenosis severity and the myocardial perfusion imaging finding of ischemia.
Seventy-two patients (41 men, 31 women; mean age, 56 years) underwent coronary CT angiography and stress-rest SPECT myocardial perfusion imaging. Calcium scoring was performed. Coronary CT angiograms were analyzed for stenosis and noncalcified or mixed plaque. A plaque analysis tool was used to calculate the volume of noncalcified plaque components. SPECT images were analyzed for perfusion defects. Data were analyzed per patient and per vessel.
A total of 53 purely noncalcified, 50 mixed, and 201 purely calcified plaques were detected. Forty-five stenoses were rated > or = 50%, 19 of those being > or = 70%. Myocardial perfusion imaging depicted perfusion defects in 37 vessels (13%) in 24 patients (18 reversible, 19 fixed defects). Vessels with > or = 50% stenosis had significantly (p = 0.0009) more perfusion defects in their supplied territories (11 with, 22 without perfusion defects) than did vessels without significant lesions (26 with, 229 without perfusion defects). In vessel-based analysis, the sensitivity of coronary CT angiography in prediction of any perfusion defect on myocardial perfusion images was 30% with 91% specificity, 33% positive predictive value, and 90% negative predictive value. Between vessels with and those without perfusion defects, there was no significant difference in Agatston or calcium volume score (p = 0.25), but there was a significant difference in noncalcified plaque volume (44 +/- 77 vs 19 +/- 58 mm(3); p = 0.03). Multiple stepwise regression analysis showed noncalcified plaque volume was the only significant predictor of ischemia (p = 0.01).
At coronary CT angiography, noncalcified plaque burden is a better predictor of the finding of myocardial ischemia at stress myocardial perfusion imaging than are calcium score and degree of stenosis.
本研究旨在探讨钙化斑块与非钙化斑块负荷、狭窄严重程度的冠状动脉CT血管造影表现与心肌灌注成像缺血表现之间的关系。
72例患者（41例男性，31例女性；平均年龄56岁）接受了冠状动脉CT血管造影和静息-负荷单光子发射计算机断层扫描（SPECT）心肌灌注成像检查。进行了钙化评分。分析冠状动脉CT血管造影的狭窄及非钙化或混合斑块情况。使用斑块分析工具计算非钙化斑块成分的体积。分析SPECT图像的灌注缺损情况。数据按患者和血管进行分析。
共检测到53个纯非钙化斑块、50个混合斑块和201个纯钙化斑块。45处狭窄程度评级为≥50%，其中19处≥70%。心肌灌注成像显示24例患者（18例可逆性缺损，19例固定性缺损）的37支血管（13%）存在灌注缺损。狭窄程度≥50%的血管在其供血区域的灌注缺损（11处有灌注缺损，22处无灌注缺损）显著（p = 0.0009）多于无明显病变的血管（26处有灌注缺损，229处无灌注缺损）。在基于血管的分析中，冠状动脉CT血管造影预测心肌灌注图像上任何灌注缺损的敏感性为30%，特异性为91%，阳性预测值为33%，阴性预测值为90%。有灌注缺损和无灌注缺损的血管之间，阿加斯顿积分或钙体积积分无显著差异（p = 0.25），但非钙化斑块体积有显著差异（44±77 vs 19±58 mm³；p = 环03）。多元逐步回归分析显示，非钙化斑块体积是缺血的唯一显著预测因子（p = 0.01）。
在冠状动脉CT血管造影中，非钙化斑块负荷比钙化积分和狭窄程度更能预测负荷心肌灌注成像时的心肌缺血表现。
