应用自动、运动校正、彩色编码灌注图检测心肌缺血与 3T 腺苷应激心血管磁共振成像的视觉分析比较：一项初步研究。

Detection of myocardial ischemia by automated, motion-corrected, color-encoded perfusion maps compared with visual analysis of adenosine stress cardiovascular magnetic resonance imaging at 3 T: a pilot study.

机构信息

First Department of Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany.

出版信息

Invest Radiol. 2013 Sep;48(9):678-86. doi: 10.1097/RLI.0b013e31828c351a.

DOI:10.1097/RLI.0b013e31828c351a

PMID:23563196

Abstract

PURPOSE

The purpose of this study was to compare automated, motion-corrected, color-encoded (AMC) perfusion maps with qualitative visual analysis of adenosine stress cardiovascular magnetic resonance imaging for detection of flow-limiting stenoses.

MATERIALS AND METHODS

Myocardial perfusion measurements applying the standard adenosine stress imaging protocol and a saturation-recovery temporal generalized autocalibrating partially parallel acquisition (t-GRAPPA) turbo fast low angle shot (Turbo FLASH) magnetic resonance imaging sequence were performed in 25 patients using a 3.0-T MAGNETOM Skyra (Siemens Healthcare Sector, Erlangen, Germany). Perfusion studies were analyzed using AMC perfusion maps and qualitative visual analysis. Angiographically detected coronary artery (CA) stenoses greater than 75% or 50% or more with a myocardial perfusion reserve index less than 1.5 were considered as hemodynamically relevant. Diagnostic performance and time requirement for both methods were compared. Interobserver and intraobserver reliability were also assessed.

RESULTS

A total of 29 CA stenoses were included in the analysis. Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy for detection of ischemia on a per-patient basis were comparable using the AMC perfusion maps compared to visual analysis. On a per-CA territory basis, the attribution of an ischemia to the respective vessel was facilitated using the AMC perfusion maps. Interobserver and intraobserver reliability were better for the AMC perfusion maps (concordance correlation coefficient, 0.94 and 0.93, respectively) compared to visual analysis (concordance correlation coefficient, 0.73 and 0.79, respectively). In addition, in comparison to visual analysis, the AMC perfusion maps were able to significantly reduce analysis time from 7.7 (3.1) to 3.2 (1.9) minutes (P < 0.0001).

CONCLUSIONS

The AMC perfusion maps yielded a diagnostic performance on a per-patient and on a per-CA territory basis comparable with the visual analysis. Furthermore, this approach demonstrated higher interobserver and intraobserver reliability as well as a better time efficiency when compared to visual analysis.

摘要

目的

本研究旨在比较自动运动校正彩色编码（AMC）灌注图与腺苷应激心血管磁共振成像的定性视觉分析，以检测限制血流的狭窄。

材料与方法

本研究在 25 例患者中应用标准腺苷应激成像方案和饱和恢复时间广义自动校准部分并行采集（t-GRAPPA）涡轮快速低角度 shot（Turbo FLASH）磁共振成像序列进行心肌灌注测量，采用 3.0-T MAGNETOM Skyra（西门子医疗部门，德国埃尔兰根）。灌注研究使用 AMC 灌注图和定性视觉分析进行分析。造影检测到的冠状动脉（CA）狭窄大于 75%或 50%以上，且心肌灌注储备指数小于 1.5，被认为是血流动力学相关的。比较了两种方法的诊断性能和时间要求。还评估了观察者间和观察者内的可靠性。

结果

共纳入 29 例 CA 狭窄进行分析。基于患者的分析，使用 AMC 灌注图检测缺血的敏感性、特异性、阳性预测值、阴性预测值和准确性与视觉分析相当。基于 CA 区域的分析，使用 AMC 灌注图更有利于将缺血归因于相应的血管。与视觉分析相比，AMC 灌注图的观察者间和观察者内可靠性更好（一致性相关系数分别为 0.94 和 0.93）。此外，与视觉分析相比，AMC 灌注图能够将分析时间从 7.7（3.1）分钟显著缩短至 3.2（1.9）分钟（P < 0.0001）。