Department of Medicine, Division of Cardiology, Johns Hopkins University, 600 N. Wolfe Street, Carnegie Building 565C, Baltimore, MD 21287, USA.
J Cardiovasc Transl Res. 2011 Aug;4(4):437-48. doi: 10.1007/s12265-011-9286-y. Epub 2011 Jun 14.
Methods for non-invasive, cardiac risk assessment have historically relied on exercise stress testing with or without echocardiography or radionuclide imaging and pharmacological stress testing when appropriate. More recently, CT-based modalities like CT angiography (CTA) have been shown to reliably differentiate low from high-risk coronary disease. The advent of newer CT technology now allows for CT-based myocardial perfusion imaging (CTP) that provides functional information, that when analyzed with anatomic data from CTA, can provide a comprehensive risk assessment strategy. In this review, we discuss the research and implementation; as well as the quantitative, semiquantitative, and qualitative methods of image analysis of CT-based perfusion. We also discuss the present state of technology and challenges associated with the methodology. In each section, when appropriate, we provide some information regarding the translation of these methods being utilized in the international, multicenter CORE320 study that is evaluating the combined CT-based imaging (CTA and CTP) strategy of risk assessment in comparison to the combined reference standard of radionuclide myocardial perfusion imaging and invasive angiography.
方法非侵入性的，心脏风险评估一直依赖于运动应激试验，伴有或不伴有超声心动图或放射性核素成像，以及适当的药物应激试验。最近，基于 CT 的方式，如 CT 血管造影（CTA），已经被证明能够可靠地区分低风险和高风险的冠状动脉疾病。较新的 CT 技术的出现现在允许基于 CT 的心肌灌注成像（CTP），它提供功能信息，当与 CTA 的解剖数据一起分析时，可以提供一种全面的风险评估策略。在这篇综述中，我们讨论了研究和实施情况；以及基于 CT 的灌注的图像分析的定量、半定量和定性方法。我们还讨论了该技术的现状以及与该方法相关的挑战。在每个部分中，我们适当地提供了一些关于这些方法在国际多中心 CORE320 研究中的翻译信息，该研究正在评估基于 CT 的成像（CTA 和 CTP）策略在比较放射性核素心肌灌注成像和有创血管造影的联合参考标准方面的风险评估。
