Department of Imaging, Division of Nuclear Medicine, Cedars-Sinai Medical Center, Los Angeles, California 90048, USA.
JACC Cardiovasc Imaging. 2010 Oct;3(10):1010-9. doi: 10.1016/j.jcmg.2010.07.011.
We compared electrocardiogram-gated computed tomography (CT) myocardial perfusion imaging (MPI) based on quantification of the extent and severity of perfusion abnormalities to that measured with single-photon emission computed tomography (SPECT) MPI.
Contrast-enhanced CT-MPI has been used for the identification of myocardial ischemia.
We performed CT-MPI during intravenous adenosine infusion in 30 patients with perfusion abnormalities on rest/adenosine stress SPECT-MPI acquired within 60 days (18 stress-rest CT-MPI and 12 stress CT-MPI only). The extent and severity of perfusion defects on SPECT-MPI were assessed on a 5-point scale in a standard 17-segment model, and total perfusion deficit (TPD) was quantified by automated software. The extent and severity of perfusion defects on CT-MPI was visually assessed by 2 observers using the same grading scale and expressed as summed stress score and summed rest score; visually quantified TPD was given by summed stress score/(maximal score of 68) and summed rest score/68. The magnitude of perfusion abnormality on CT-MPI in regions of the myocardium was defined.
On a per-segment basis, there was good agreement between CT-MPI and SPECT-MPI with a kappa of 0.71 (p < 0.0001) for detection of stress perfusion abnormalities. Automated TPD on SPECT-MPI was similar to visual TPD from CT-MPI (p = 0.65 stress TPD, and p = 0.12 ischemic TPD stress-rest) with excellent agreement (bias = -0.3 for stress TPD, and bias = 1.2 for ischemic TPD) on Bland-Altman analysis. Software-based quantification of the magnitude of stress perfusion deficit and ischemia on CT-MPI were similar to that for automated TPD measured by SPECT (p = 0.88 stress, and p = 0.48 ischemia), with minimal bias (bias = 0.6, and bias = 1.2).
Stress and reversible myocardial perfusion deficit measured by CT-MPI using a visual semiquantitative approach and a visually guided software-based approach show strong similarity with SPECT-MPI, suggesting that CT-MPI-based assessment of myocardial perfusion defects may be of clinical and prognostic value.
我们比较了基于定量评估灌注异常程度和范围的心电图门控计算机断层扫描（CT）心肌灌注成像（MPI）与单光子发射计算机断层扫描（SPECT）MPI 的测量结果。
对比增强 CT-MPI 已用于识别心肌缺血。
我们在 30 例静息/腺苷应激 SPECT-MPI 显示灌注异常的患者中进行了 CT-MPI，这些患者在 60 天内接受了静脉注射腺苷（18 例应激-静息 CT-MPI 和 12 例仅应激 CT-MPI）。SPECT-MPI 上的灌注缺陷程度和范围在标准的 17 节段模型上按 5 分制进行评估，并通过自动软件量化总灌注缺损（TPD）。CT-MPI 上的灌注缺陷程度和范围由 2 名观察者使用相同的分级量表进行视觉评估，并表示为总和应激评分和总和静息评分；视觉量化的 TPD 由总和应激评分/（最大 68 分）和总和静息评分/68 给出。还定义了心肌区域内灌注异常的程度。
在节段水平上，CT-MPI 和 SPECT-MPI 之间具有良好的一致性，kappa 值为 0.71（p<0.0001），用于检测应激性灌注异常。SPECT-MPI 上的自动 TPD 与 CT-MPI 的视觉 TPD 相似（应激 TPD 时 p=0.65，应激-静息 TPD 时 p=0.12），Bland-Altman 分析显示具有极好的一致性（应激 TPD 时的偏差=0.3，缺血性 TPD 时的偏差=1.2）。CT-MPI 上的应激灌注缺损和缺血性程度的软件定量与 SPECT 测量的自动 TPD 相似（应激时 p=0.88，缺血时 p=0.48），偏差最小（偏差=0.6，偏差=1.2）。
使用视觉半定量方法和视觉引导的软件方法测量 CT-MPI 时的应激和可逆性心肌灌注缺损与 SPECT-MPI 具有很强的相似性，表明 CT-MPI 评估心肌灌注缺损可能具有临床和预后价值。
