Mordini Federico E, Haddad Tariq, Hsu Li-Yueh, Kellman Peter, Lowrey Tracy B, Aletras Anthony H, Bandettini W Patricia, Arai Andrew E
Cardiovascular and Pulmonary Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland; Department of Cardiology, Veterans Affairs Medical Center, Washington, DC.
Cardiovascular and Pulmonary Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland.
JACC Cardiovasc Imaging. 2014 Jan;7(1):14-22. doi: 10.1016/j.jcmg.2013.08.014.
This study's primary objective was to determine the sensitivity, specificity, and accuracy of fully quantitative stress perfusion cardiac magnetic resonance (CMR) versus a reference standard of quantitative coronary angiography. We hypothesized that fully quantitative analysis of stress perfusion CMR would have high diagnostic accuracy for identifying significant coronary artery stenosis and exceed the accuracy of semiquantitative measures of perfusion and qualitative interpretation.
Relatively few studies apply fully quantitative CMR perfusion measures to patients with coronary disease and comparisons to semiquantitative and qualitative methods are limited.
Dual bolus dipyridamole stress perfusion CMR exams were performed in 67 patients with clinical indications for assessment of myocardial ischemia. Stress perfusion images alone were analyzed with a fully quantitative perfusion (QP) method and 3 semiquantitative methods including contrast enhancement ratio, upslope index, and upslope integral. Comprehensive exams (cine imaging, stress/rest perfusion, late gadolinium enhancement) were analyzed qualitatively with 2 methods including the Duke algorithm and standard clinical interpretation. A 70% or greater stenosis by quantitative coronary angiography was considered abnormal.
The optimum diagnostic threshold for QP determined by receiver-operating characteristic curve occurred when endocardial flow decreased to <50% of mean epicardial flow, which yielded a sensitivity of 87% and specificity of 93%. The area under the curve for QP was 92%, which was superior to semiquantitative methods: contrast enhancement ratio: 78%; upslope index: 82%; and upslope integral: 75% (p = 0.011, p = 0.019, p = 0.004 vs. QP, respectively). Area under the curve for QP was also superior to qualitative methods: Duke algorithm: 70%; and clinical interpretation: 78% (p < 0.001 and p < 0.001 vs. QP, respectively).
Fully quantitative stress perfusion CMR has high diagnostic accuracy for detecting obstructive coronary artery disease. QP outperforms semiquantitative measures of perfusion and qualitative methods that incorporate a combination of cine, perfusion, and late gadolinium enhancement imaging. These findings suggest a potential clinical role for quantitative stress perfusion CMR.
本研究的主要目的是确定全定量负荷灌注心脏磁共振成像（CMR）相对于定量冠状动脉造影参考标准的敏感性、特异性和准确性。我们假设，全定量分析负荷灌注CMR在识别显著冠状动脉狭窄方面具有较高的诊断准确性，且超过灌注半定量测量和定性解读的准确性。
相对较少的研究将全定量CMR灌注测量应用于冠心病患者，并且与半定量和定性方法的比较有限。
对67例有心肌缺血评估临床指征的患者进行双团注双嘧达莫负荷灌注CMR检查。仅对负荷灌注图像采用全定量灌注（QP）方法以及3种半定量方法进行分析，这3种半定量方法包括对比增强率、上升斜率指数和上升斜率积分。采用包括杜克算法和标准临床解读在内的2种方法对综合检查（电影成像、负荷/静息灌注、延迟钆增强）进行定性分析。定量冠状动脉造影显示狭窄70%或更高被视为异常。
通过受试者操作特征曲线确定的QP最佳诊断阈值为心内膜血流降至平均心外膜血流的<50%时，其敏感性为87%，特异性为93%。QP的曲线下面积为92%，优于半定量方法：对比增强率：78%；上升斜率指数：82%；上升斜率积分：75%（分别与QP相比，p = 0.011、p = 0.019、p = 0.004）。QP的曲线下面积也优于定性方法：杜克算法：70%；临床解读：78%（分别与QP相比，p < 0.001和p < 0.001）。
全定量负荷灌注CMR在检测阻塞性冠状动脉疾病方面具有较高的诊断准确性。QP优于灌注半定量测量以及结合电影、灌注和延迟钆增强成像的定性方法。这些发现提示了定量负荷灌注CMR潜在的临床作用。
