使用256层计算机断层扫描对三磷酸腺苷负荷全心动态心肌灌注成像进行定性和定量评估。

Qualitative and quantitative assessment of adenosine triphosphate stress whole-heart dynamic myocardial perfusion imaging using 256-slice computed tomography.

作者信息

Kurata Akira, Kawaguchi Naoto, Kido Teruhito, Inoue Katsuji, Suzuki Jun, Ogimoto Akiyoshi, Funada Jun-ichi, Higaki Jitsuo, Miyagawa Masao, Vembar Mani, Mochizuki Teruhito

机构信息

Department of Diagnostic and Therapeutic Radiology, Ehime University Graduate School of Medicine, Ehime, Japan.

Department of Integrated Medicine and Informatics, Ehime University Graduate School of Medicine, Ehime, Japan.

出版信息

PLoS One. 2013 Dec 23;8(12):e83950. doi: 10.1371/journal.pone.0083950. eCollection 2013.

BACKGROUND

The aim of this study was to investigate the correlation of the qualitative transmural extent of hypoperfusion areas (HPA) using stress dynamic whole-heart computed tomography perfusion (CTP) imaging by 256-slice CT with CTP-derived myocardial blood flow (MBF) for the estimation of the severity of coronary artery stenosis.

METHODS AND RESULTS

Eleven patients underwent adenosine triphosphate (0.16 mg/kg/min, 5 min) stress dynamic CTP by 256-slice CT (coverage: 8 cm, 0.27 s/rotation), and 9 of the 11 patients underwent coronary angiography (CAG). Stress dynamic CTP (whole-heart datasets over 30 consecutive heart beats in systole without spatial and temporal gaps) was acquired with prospective ECG gating (effective radiation dose: 10.4 mSv). The extent of HPAs was visually graded using a 3-point score (normal, subendocardial, transmural). MBF (ml/100g/min) was measured by deconvolution. Differences in MBF (mean ± standard error) according to HPA and CAG results were evaluated. In 27 regions (3 major coronary territories in 9 patients), 11 coronary stenoses (> 50% reduction in diameter) were observed. In 353 myocardial segments, HPA was significantly related to MBF (P < 0.05; normal 295 ± 94; subendocardial 186 ± 67; and transmural 80 ± 53). Coronary territory analysis revealed a significant relationship between coronary stenosis severity and MBF (P < 0.05; non-significant stenosis [< 50%], 284 ± 97; moderate stenosis [50-70%], 184 ± 74; and severe stenosis [> 70%], 119 ± 69).

CONCLUSION

The qualitative transmural extent of HPA using stress whole-heart dynamic CTP imaging by 256-slice CT exhibits a good correlation with quantitative CTP-derived MBF and may aid in assessing the hemodynamic significance of coronary artery disease.

背景

本研究旨在通过256层CT的应力动态全心脏计算机断层扫描灌注（CTP）成像，研究灌注减低区（HPA）的定性透壁范围与CTP衍生的心肌血流量（MBF）之间的相关性，以评估冠状动脉狭窄的严重程度。

方法与结果

11例患者接受了256层CT的三磷酸腺苷（0.16mg/kg/min，5分钟）应力动态CTP检查（覆盖范围：8cm，0.27秒/旋转），11例患者中的9例接受了冠状动脉造影（CAG）。采用前瞻性心电图门控获取应力动态CTP（收缩期连续30个心跳的全心脏数据集，无空间和时间间隙）（有效辐射剂量：10.4mSv）。使用3分评分（正常、心内膜下、透壁）对HPA的范围进行视觉分级。通过去卷积测量MBF（ml/100g/min）。评估根据HPA和CAG结果的MBF差异（平均值±标准误差）。在27个区域（9例患者的3个主要冠状动脉区域），观察到11处冠状动脉狭窄（直径减少>50%）。在353个心肌节段中，HPA与MBF显著相关（P<0.05；正常295±94；心内膜下186±67；透壁80±53）。冠状动脉区域分析显示冠状动脉狭窄严重程度与MBF之间存在显著关系（P<0.05；非显著狭窄[<50%]，284±97；中度狭窄[50-70%]，184±74；重度狭窄[>70%]，119±69）。