冠状动脉造影与心肌灌注成像在评估功能相关冠状动脉病变中的比较

[Comparison of coronary angiography with myocardial perfusion imaging in assessment of functionally relevant coronary artery lesion].

作者信息

Peng Ze-hua, Huang Ji-yuan, Pu Hong, Bai Lin, Chen Jia-yuan, Li Gang, Huang Jin

机构信息

Department of Radiology, Sichuan Provincial Academy of Medical Science and Sichuan Provincial People's Hospital, Chengdu 610072, China.

出版信息

Zhonghua Xin Xue Guan Bing Za Zhi. 2010 Jul;38(7):601-5.

PMID:21055281

Abstract

OBJECTIVE

To evaluate the accuracy of dual-source CT coronary angiography (DSCTCA) for the depiction of functionally relevant coronary artery lesion(FRCAL), by using myocardial perfusion imaging (MPI) with single photon emission computed tomography (SPECT).

METHODS

DSCTCA, (99)Tc(m)-MIBI SPECT myocardial perfusion imaging (MPI) and conventional coronary angiography (CCA) were performed in 59 patients with clinical suspected CAD. Coronary artery diameter narrowing of 50% or greater at DSCTCA was defined as stenosis and was compared with MPI findings. CCA was served as a reference standard for DSCTCA.

RESULTS

(1) Agreement between DSCTCA and CCA was good (kappa = 0.93 for patient-based analysis, Kappa = 0.88 for vessel-based analysis). (2) DSCTCA revealed stenoses in 86 segments corresponding to 60 arteries in 34 patients. (3) MPI revealed 19 reversible, 21 partially reversible, and 5 fixed defects in 25 patients. (4) About 65.0% (39/60) of all the narrowed coronary arteries were determined to be FRCAL. Sensitivity, specificity, accuracy, positive predictive values and negative predictive values, respectively, of DSCTCA in the detection of all MPI defects were 92.0%, 67.6%, 78.0%, 67.6% and 92.0% on a per-patient basis and 86.7%, 89.0%, 88.6%, 65.0% and 96.6% on a per-artery basis. (5) ROC analysis showed that predictive value of DSCTCA in FRCAL was similar with those of CCA (AUCs = 0.80, 0.82).

CONCLUSIONS

DSCTCA can evaluate FRCAL indirectly. When DSCTCA results are negative, it can help ruled out patients with FRCAL. The positive DSCTCA results should combine MPI in predictor of myocardial ischemia.

摘要

目的

通过单光子发射计算机断层扫描（SPECT）心肌灌注成像（MPI）评估双源CT冠状动脉造影（DSCTCA）对功能相关冠状动脉病变（FRCAL）的显示准确性。

方法

对59例临床怀疑冠心病的患者进行DSCTCA、（99）锝-甲氧基异丁基异腈（99）Tc（m）-MIBI SPECT心肌灌注成像（MPI）和传统冠状动脉造影（CCA）检查。DSCTCA显示冠状动脉直径狭窄50%或以上定义为狭窄，并与MPI结果进行比较。CCA作为DSCTCA的参考标准。

结果

（1）DSCTCA与CCA之间的一致性良好（基于患者分析的kappa = 0.93，基于血管分析的kappa = 0.88）。（2）DSCTCA显示34例患者中60条动脉对应的86个节段存在狭窄。（3）MPI显示25例患者中有19个可逆性、21个部分可逆性和5个固定性缺损。（4）所有狭窄冠状动脉中约65.0%（39/60）被确定为FRCAL。DSCTCA检测所有MPI缺损时，基于患者的敏感性、特异性、准确性、阳性预测值和阴性预测值分别为92.0%、67.6%、78.0%、67.6%和92.0%，基于动脉的分别为86.7%、89.0%、88.6%、65.0%和96.6%。（5）ROC分析显示DSCTCA对FRCAL的预测价值与CCA相似（曲线下面积[AUCs] = 0.80，0.82）。