Department of Radiology, Albert Einstein College of Medicine, Montefiore Medical Center, 111 East 210th St, Bronx, NY 10467-2490, USA.
AJR Am J Roentgenol. 2013 Feb;200(2):337-42. doi: 10.2214/AJR.11.8171.
CT myocardial perfusion imaging is an emerging diagnostic modality that is under intensive study but not yet widely used in clinical practice. The purpose of this study is to evaluate the performance of resting 64-MDCT in revealing ischemia identified on radionuclide myocardial perfusion imaging (MPI).
We retrospectively identified 35 patients (20 women and 15 men; mean age, 52 years) with myocardial ischemia found on MPI who underwent retrospectively gated CT within 90 days of MPI. Myocardial perfusion on CT was evaluated using both a visual (n = 35) and an automated (n = 34) method. For the visual method, myocardial segments were evaluated qualitatively in systole and diastole. For the automated method, subendocardial perfusion of the standard 17 American Heart Association segments was measured using a commercially available tool in both systole and diastole. Differences between systolic and diastolic perfusion were computed.
Five hundred eighty myocardial segments were evaluated, 152 of which were ischemic on MPI. Visual analysis had a sensitivity of 16% (24/152), specificity of 92% (393/428), positive predictive value of 40% (24/60), and negative predictive value of 75% (392/520) in systole, and a sensitivity of 18% (27/152), specificity of 89% (382/428), positive predictive value of 37% (27/73), and negative predictive value of 75% (382/507) in diastole, as compared with MPI. There was no significant difference in subendocardial perfusion between ischemic and nonischemic segments by the automated method. There was no significant difference in CT perfusion between patients with and without obstructive coronary artery disease on CT angiography using the visual or automated methods.
Resting 64-MDCT is unsuitable for clinical use in revealing ischemia seen on MPI.
CT 心肌灌注成像是一种新兴的诊断方式，目前正在深入研究中，但尚未在临床实践中广泛应用。本研究旨在评估静息状态下 64 层 MDCT 显示放射性核素心肌灌注成像（MPI）确定的缺血性病变的性能。
我们回顾性地确定了 35 例 MPI 显示心肌缺血的患者（20 名女性和 15 名男性；平均年龄 52 岁），这些患者在 MPI 后 90 天内行回顾性门控 CT 检查。使用视觉（n = 35）和自动（n = 34）方法评估 CT 心肌灌注。对于视觉方法，在收缩期和舒张期对心肌节段进行定性评估。对于自动方法，使用一种商用工具测量标准 17 个美国心脏协会节段的心肌心内膜下灌注，分别在收缩期和舒张期进行测量。计算收缩期和舒张期灌注之间的差异。
共评估了 580 个心肌节段，其中 152 个节段在 MPI 上显示为缺血。在收缩期，视觉分析的敏感性为 16%（24/152），特异性为 92%（393/428），阳性预测值为 40%（24/60），阴性预测值为 75%（392/520）；在舒张期，敏感性为 18%（27/152），特异性为 89%（382/428），阳性预测值为 37%（27/73），阴性预测值为 75%（382/507），与 MPI 相比，差异均无统计学意义。使用自动方法，缺血和非缺血节段的心内膜下灌注之间无显著差异。使用视觉或自动方法，CT 血管造影显示 CT 上存在或不存在阻塞性冠状动脉疾病的患者之间 CT 灌注无显著差异。
静息状态下 64 层 MDCT 不适合用于显示 MPI 所见的缺血性病变。
