Cury Roberto C, Magalhães Tiago A, Borges Anna C, Shiozaki Afonso A, Lemos Pedro A, Júnior José Soares, Meneghetti José Cláudio, Cury Ricardo C, Rochitte Carlos E
Cardiovascular MR and CT Section, University of São Paulo Medical, School, São Paulo, Brazil.
Am J Cardiol. 2010 Aug 1;106(3):310-5. doi: 10.1016/j.amjcard.2010.03.025.
Recently, stress myocardial computed tomographic perfusion (CTP) was shown to detect myocardial ischemia. Our main objective was to evaluate the feasibility of dipyridamole stress CTP and compare it to single-photon emission computed tomography (SPECT) to detect significant coronary stenosis using invasive conventional coronary angiography (CCA; stenosis >70%) as the reference method. Thirty-six patients (62 +/- 8 years old, 20 men) with previous positive results with SPECT (<2 months) as the primary inclusion criterion and suspected coronary artery disease underwent a customized multidetector-row CT protocol with myocardial perfusion evaluation at rest and during stress and coronary CT angiography (CTA). Multidetector-row computed tomography was performed in a 64-slice scanner with dipyridamole stress perfusion acquisition before a second perfusion/CT angiographic acquisition at rest. Independent blinded observers performed analysis of images from CTP, CTA, and CCA. All 36 patients completed the CT protocol with no adverse events (mean radiation dose 14.7 +/- 3.0 mSv) and with interpretable scans. CTP results were positive in 27 of 36 patients (75%). From the 9 (25%) disagreements, 6 patients had normal coronary arteries and 2 had no significant stenosis (8 false-positive results with SPECT, 22%). The remaining patient had an occluded artery with collateral flow confirmed by conventional coronary angiogram. Good agreement was demonstrated between CTP and SPECT on a per-patient analysis (kappa 0.53). In 26 patients using CCA as reference, sensitivity, specificity, and positive and negative predictive values were 88.0%, 79.3%, 66.7%, and 93.3% for CTP and 68.8, 76.1%, 66.7%, and 77.8%, for SPECT, respectively (p = NS). In conclusion, dipyridamole CT myocardial perfusion at rest and during stress is feasible and results are similar to single-photon emission CT scintigraphy. The anatomical-perfusion information provided by this combined CT protocol may allow identification of false-positive results by SPECT.
最近，应激心肌计算机断层扫描灌注成像（CTP）已被证明可检测心肌缺血。我们的主要目的是评估双嘧达莫应激CTP的可行性，并将其与单光子发射计算机断层扫描（SPECT）进行比较，以采用有创性传统冠状动脉造影（CCA；狭窄>70%）作为参考方法来检测显著的冠状动脉狭窄。36例患者（年龄62±8岁，男性20例），以既往SPECT检查结果为阳性（<2个月）作为主要纳入标准，且怀疑患有冠状动脉疾病，接受了定制的多排探测器CT检查方案，包括静息及应激状态下的心肌灌注评估以及冠状动脉CT血管造影（CTA）。在64层扫描仪上进行多排探测器计算机断层扫描，在静息状态下进行第二次灌注/CT血管造影采集之前先进行双嘧达莫应激灌注采集。独立的盲法观察者对CTP、CTA和CCA的图像进行分析。所有36例患者均完成了CT检查方案，未出现不良事件（平均辐射剂量14.7±3.0 mSv），且扫描图像可进行解读。36例患者中有27例（75%）CTP结果为阳性。在9例（25%）结果不一致的患者中，6例冠状动脉正常，2例无显著狭窄（SPECT有8例假阳性结果，占22%）。其余1例患者经传统冠状动脉造影证实为动脉闭塞且有侧支循环。在对每位患者的分析中，CTP与SPECT之间显示出良好的一致性（kappa值为0.53）。以CCA作为参考，在26例患者中，CTP的敏感性、特异性、阳性预测值和阴性预测值分别为88.0%、79.3%、66.7%和93.3%，SPECT的分别为68.8%、76.1%、66.7%和77.8%（p=无显著性差异）。总之，静息及应激状态下的双嘧达莫CT心肌灌注检查是可行的，结果与单光子发射CT闪烁扫描相似。这种联合CT检查方案所提供的解剖学-灌注信息可能有助于识别SPECT的假阳性结果。
