Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio 44195, USA.
J Nucl Med. 2011 Jul;52(7):1079-86. doi: 10.2967/jnumed.110.081133. Epub 2011 Jun 16.
Both anatomy- and physiology-based approaches to patient management have advantages and limitations. Compared with the latter, the former has a superior ability to exclude disease and does not miss high-risk coronary artery disease (CAD). However, it is limited by a possibility of overestimating the severity of CAD and of potentially failing to determine which posttest therapeutic approach optimizes treatment benefit. On the other hand, although a physiology-based approach could potentially identify optimal therapeutic strategies, the possibility of both false-positive and false-negative findings is a concern. This review incorporates some of the more recent advances in CT coronary angiography and myocardial perfusion imaging (MPI), including PET MPI, into a discussion of anatomic versus physiologic imaging and provides our perspective on how an anatomy-based testing strategy centered in CT coronary angiography versus a physiology-based testing strategy with MPI may be clinically used for the evaluation of known or suspected CAD in symptomatic patients.
解剖学和生理学方法在患者管理方面都有各自的优势和局限性。与后者相比，前者排除疾病的能力更强，不会错过高危冠状动脉疾病（CAD）。然而，它也存在高估 CAD 严重程度的可能性，并且可能无法确定哪种后续治疗方法能最大程度地提高治疗效果。另一方面，尽管生理学方法可能有助于确定最佳治疗策略，但假阳性和假阴性结果的可能性令人担忧。本综述将 CT 冠状动脉成像和心肌灌注成像（MPI）的一些最新进展，包括正电子发射断层扫描 MPI，纳入到解剖学与生理学成像的讨论中，并就基于 CT 冠状动脉成像的解剖学检测策略与基于 MPI 的生理学检测策略如何在临床上用于评估有症状的已知或疑似 CAD 患者提供了我们的观点。
