腺苷负荷 CT 灌注+CT 血管成像联合跨壁衰减梯度+CT 血管成像与有创性血流储备分数对比诊断准确性的比较。
Comparison of diagnostic accuracy of combined assessment using adenosine stress computed tomography perfusion + computed tomography angiography with transluminal attenuation gradient + computed tomography angiography against invasive fractional flow reserve.
机构信息
Monash Cardiovascular Research Centre, Department of Medicine, Monash Medical Centre, Monash University and MonashHeart, Monash Health, Clayton, Australia; Discipline of Medicine, University of Adelaide, Adelaide, Australia.
Monash Cardiovascular Research Centre, Department of Medicine, Monash Medical Centre, Monash University and MonashHeart, Monash Health, Clayton, Australia.
出版信息
J Am Coll Cardiol. 2014 May 13;63(18):1904-12. doi: 10.1016/j.jacc.2014.02.557. Epub 2014 Mar 19.
OBJECTIVES
The goal of this study was to compare the diagnostic accuracy of combined computed tomography perfusion (CTP) + computed tomography angiography (CTA), transluminal attenuation gradient by 320-detector row computed tomography (TAG320) + CTA, and CTP + TAG320 + CTA (multidetector computed tomography-integrated protocol [MDCT-IP]) assessment in predicting significant fractional flow reserve (FFR).
BACKGROUND
CTA has limited specificity for predicting functionally significant stenoses. Novel CT techniques, including adenosine stress CTP and TAG320, may improve the diagnostic accuracy of CTA.
METHODS
CTA, CTP, and TAG320 were assessed using 320-detector row MDCT. Patients who underwent CTA, CTP, and FFR assessment on invasive coronary angiography were included. CTP was assessed using the visual perfusion assessment. TAG320 was defined as the linear regression coefficient between luminal attenuation and axial distance. A TAG320 cutoff value of -15.1 HU/10 mm as previously described was defined as significant. Functionally significant coronary stenosis was defined as FFR ≤0.8.
RESULTS
The cohort included 75 patients (age 64.1 ± 10.8 years, 52 men) and 44 (35%) FFR-significant vessels. In 127 vessels, CTA predicted FFR-significant stenosis with 89% sensitivity and 65% specificity compared with MDCT-IP, which showed 88% sensitivity and 83% specificity. In 97 vessels in which the results of all techniques were available, TAG320 + CTA (area under the curve [AUC] = 0.844) and CTP + CTA (AUC = 0.845) had comparable per-vessel diagnostic accuracy (p = 0.98). The diagnostic accuracy of MDCT-IP (AUC = 0.91) was superior to TAG320 + CTA or CTP + CTA (p = 0.01).
CONCLUSIONS
In vessels without significant calcification or artefact, TAG320 + CTA and CTP + CTA provide comparable diagnostic accuracy for functional assessment of coronary artery stenosis. MDCT-IP may provide the best diagnostic accuracy for functional assessment of coronary artery stenosis.
目的
本研究旨在比较联合计算机断层灌注（CTP）+计算机断层血管造影（CTA）、320 层探测器 CT 管腔衰减梯度（TAG320）+ CTA 以及 CTP+TAG320+CTA（多探测器计算机断层扫描整合方案[MDCT-IP]）评估在预测有意义的血流储备分数（FFR）中的诊断准确性。
背景
CTA 对预测有功能意义的狭窄具有有限的特异性。新型 CT 技术，包括腺苷应激 CTP 和 TAG320，可能提高 CTA 的诊断准确性。
方法
采用 320 层探测器 MDCT 评估 CTA、CTP 和 TAG320。纳入在有创冠状动脉造影中接受 CTA、CTP 和 FFR 评估的患者。采用视觉灌注评估进行 CTP 评估。TAG320 定义为管腔衰减与轴向距离之间的线性回归系数。先前描述的截断值为-15.1 HU/10mm 的 TAG320 被定义为显著。功能性冠状动脉狭窄定义为 FFR≤0.8。
结果
该队列包括 75 例患者（年龄 64.1±10.8 岁，52 例男性）和 44 例（35%）FFR 显著狭窄的血管。在 127 支血管中，CTA 预测 FFR 显著狭窄的敏感性为 89%，特异性为 65%，而 MDCT-IP 的敏感性为 88%，特异性为 83%。在 97 支所有技术结果均可用的血管中，TAG320+CTA（曲线下面积[AUC] = 0.844）和 CTP+CTA（AUC = 0.845）的每支血管诊断准确性相当（p=0.98）。MDCT-IP（AUC=0.91）的诊断准确性优于 TAG320+CTA 或 CTP+CTA（p=0.01）。
结论
在没有明显钙化或伪影的血管中，TAG320+CTA 和 CTP+CTA 对冠状动脉狭窄的功能评估具有相当的诊断准确性。MDCT-IP 可能对冠状动脉狭窄的功能评估提供最佳的诊断准确性。
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