采用 CT 血管造影术无创诊断缺血性冠状动脉狭窄：血管内测量的血流储备分数与 CT 血管造影术计算的管腔衰减梯度和血流储备分数的诊断价值比较。
Noninvasive diagnosis of ischemia-causing coronary stenosis using CT angiography: diagnostic value of transluminal attenuation gradient and fractional flow reserve computed from coronary CT angiography compared to invasively measured fractional flow reserve.
机构信息
Department of Medicine, Seoul National University Hospital, Seoul, Korea.
出版信息
JACC Cardiovasc Imaging. 2012 Nov;5(11):1088-96. doi: 10.1016/j.jcmg.2012.09.002.
OBJECTIVES
The aim of this study was to compare the diagnostic performance of coronary computed tomography angiography (CCTA)-derived computed fractional flow reserve (FFR(CT)) and transluminal attenuation gradient (TAG) for the diagnosis of lesion-specific ischemia.
BACKGROUND
Although CCTA is commonly used to detect coronary artery disease (CAD), it cannot reliably assess the functional significance of CAD. Novel technologies based on CCTA were developed to integrate anatomical and functional assessment of CAD; however, the diagnostic performance of these methods has never been compared.
METHODS
Fifty-three consecutive patients who underwent CCTA and coronary angiography with FFR measurement were included. Independent core laboratories determined CAD severity by CCTA, TAG, and FFR(CT). The TAG was defined as the linear regression coefficient between intraluminal radiological attenuation and length from the ostium; FFR(CT) was computed from CCTA data using computational fluid dynamics technology.
RESULTS
Among 82 vessels, 32 lesions (39%) had ischemia by invasive FFR (FFR ≤0.80). Sensitivity, specificity, positive and negative predictive values, and positive and negative likelihood ratio of TAG (≤ -0.654 HU/mm) for detection of ischemia were 38%, 88%, 67%, 69%, 3.13, and 0.71, respectively; and those of FFR(CT) were 81%, 94%, 90%, 89%, 13.54, and 0.20, respectively. Receiver-operating characteristic curve analysis showed a significantly larger area under the curve (AUC) for FFR(CT) (0.94) compared to that for TAG (0.63, p < 0.001) and CCTA stenosis (0.73, p < 0.001). In vessels with noncalcified plaque or partially calcified plaque, FFR(CT) showed a larger AUC (0.94) compared to that of TAG (0.63, p < 0.001) or CCTA stenosis (0.70, p < 0.001). In vessels with calcified plaque, AUC of FFR(CT) (0.92) was not statistically larger than that of TAG (0.75, p = 0.168) or CCTA stenosis (0.80, p = 0.195).
CONCLUSIONS
Noninvasive FFR computed from CCTA provides better diagnostic performance for the diagnosis of lesion-specific ischemia compared to CCTA stenosis and TAG.
目的
本研究旨在比较冠状动脉计算机断层扫描血管造影术（CCTA）衍生的计算血流储备分数（FFR(CT)）和管腔衰减梯度（TAG）在诊断特定病变缺血方面的诊断性能。
背景
尽管 CCTA 常用于检测冠状动脉疾病（CAD），但它无法可靠地评估 CAD 的功能意义。已经开发了基于 CCTA 的新技术来整合 CAD 的解剖学和功能评估；然而，这些方法的诊断性能从未进行过比较。
方法
纳入 53 例连续行 CCTA 和有 FFR 测量的冠状动脉造影的患者。独立的核心实验室通过 CCTA、TAG 和 FFR(CT) 确定 CAD 严重程度。TAG 定义为管腔内放射衰减与从开口到末端的长度之间的线性回归系数；FFR(CT) 通过计算流体动力学技术从 CCTA 数据中计算得出。
结果
在 82 个血管中，32 个病变（39%）通过有创 FFR（FFR ≤0.80）检测到缺血。TAG（≤ -0.654 HU/mm）用于检测缺血的敏感性、特异性、阳性和阴性预测值以及阳性和阴性似然比分别为 38%、88%、67%、69%、3.13 和 0.71；FFR(CT) 分别为 81%、94%、90%、89%、13.54 和 0.20。受试者工作特征曲线分析显示 FFR(CT) 的曲线下面积（AUC）显著大于 TAG（0.63，p < 0.001）和 CCTA 狭窄（0.73，p < 0.001）。在非钙化斑块或部分钙化斑块的血管中，FFR(CT) 的 AUC（0.94）大于 TAG（0.63，p < 0.001）或 CCTA 狭窄（0.70，p < 0.001）。在钙化斑块血管中，FFR(CT) 的 AUC（0.92）与 TAG（0.75，p = 0.168）或 CCTA 狭窄（0.80，p = 0.195）的 AUC 无统计学差异。
结论
与 CCTA 狭窄和 TAG 相比，从 CCTA 计算得出的非侵入性 FFR 对诊断特定病变的缺血提供了更好的诊断性能。
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