Department of Cardiology, Centro Hospitalar de Gaia/Espinho, EPE, Rua Conceição Fernandes, 4434-502 Vila Nova de Gaia, Portugal.
J Cardiovasc Comput Tomogr. 2011 Nov-Dec;5(6):392-405. doi: 10.1016/j.jcct.2011.10.002. Epub 2011 Oct 22.
Preliminary studies have shown the potential of myocardial computed tomography perfusion (CTP) analysis for ischemia detection in both animals and humans.
To provide validation data on stress-rest CTP protocols as additive tools to improve the accuracy of multidetector computed tomography (MDCT) for coronary artery disease (CAD) in symptomatic patients.
Ninety symptomatic patients with suspected CAD (62 ± 8 years, 66% males) underwent both MDCT and invasive coronary angiography (XA). The MDCT protocol included a prospective calcium score acquisition, a helical acquisition with retrospective gating during infusion of adenosine (140 μg/kg/min) and a prospective scan for computed tomography angiography (CTA) at rest (total effective radiation dose: 5.1 ± 0.8 mSv). Significant and higher-grade CADs were defined by the presence of ≥50% or ≥70% stenosis in at least one coronary artery, as evaluated by quantitative coronary angiography (QCA) using XA images.
On a patient-based model, CTA sensitivity, specificity, and positive (PPV) and negative predictive values (NPV) to detect ≥50% or ≥70% stenosis were 98%, 71%, 80%, and 97% (global accuracy 86%) and 100%, 60%, 64%, and 100% (accuracy 77%), respectively. An integrative approach of CTA and CTP results had the best performance for detection of CAD with sensitivity of 83%, specificity of 98%, PPV of 98%, and NPV of 84% (accuracy 84%) for detection of 50% stenosis and 97%, 90%, 88%, and 98% (accuracy 93%), respectively, for the 70% threshold. The integration of results had the best overall performance in all scenarios but was particularly advantageous in the prediction of higher-grade CAD, with an area under the curve of 0.93, compared with 0.80 for isolated CTA and 0.82 for CTP and in patients with severe calcifications (sensitivity 92%, specificity 87%, overall accuracy of 90%).
The integration of functional and morphological data using CTA and CTP improved MDCT accuracy for detection of clinically relevant CAD at both thresholds of 50% and 70% in this intermediate to high pretest probability population.
初步研究表明，心肌计算机断层灌注（CTP）分析在动物和人体中具有检测缺血的潜力。
为应激-静息 CTP 方案提供验证数据，作为提高多排螺旋 CT（MDCT）对有症状患者冠状动脉疾病（CAD）准确性的附加工具。
90 例疑似 CAD 的有症状患者（62±8 岁，男性占 66%）接受了 MDCT 和有创冠状动脉造影（XA）检查。MDCT 方案包括前瞻性钙评分采集、腺苷（140μg/kg/min）输注时回顾性门控的螺旋采集以及静息时的 CT 血管造影（CTA）前瞻性扫描（总有效辐射剂量：5.1±0.8mSv）。通过 QCA 对 XA 图像进行评估，将至少一支冠状动脉≥50%或≥70%狭窄定义为有意义和更高等级的 CAD。
基于患者模型，CTA 检测≥50%或≥70%狭窄的敏感性、特异性、阳性（PPV）和阴性预测值（NPV）分别为 98%、71%、80%和 97%（整体准确率 86%）和 100%、60%、64%和 100%（准确率 77%）。CTA 和 CTP 结果的综合方法对 CAD 的检测具有最佳性能，检测 50%狭窄的敏感性为 83%、特异性为 98%、PPV 为 98%、NPV 为 84%（准确率 84%），检测 70%狭窄的敏感性为 97%、特异性为 90%、PPV 为 88%、NPV 为 98%（准确率 93%）。在所有情况下，综合结果的表现最佳，但在预测高级别 CAD 方面尤其有利，曲线下面积为 0.93，而单独 CTA 为 0.80，CTP 为 0.82，在严重钙化患者中为 0.90（敏感性 92%，特异性 87%，总准确率 90%）。
在这个中到高术前概率人群中，使用 CTA 和 CTP 整合功能和形态数据可提高 MDCT 检测有临床意义的 CAD 的准确性，两个狭窄程度阈值为 50%和 70%。
