Department of Radiology, Konkuk University Medical Center, Konkuk University School of Medicine, 4-12 Hwayang-dong, Gwangjin-gu, Seoul, 143-729, Korea.
Int J Cardiovasc Imaging. 2014 Jun;30 Suppl 1:41-53. doi: 10.1007/s10554-014-0410-3. Epub 2014 Apr 3.
We assessed the diagnostic performance of stress- and rest-dual-energy computed tomography (DECT) and their incremental value when used with coronary CT angiography (CCTA) compared with combined invasive coronary angiography (ICA)/cardiovascular magnetic resonance (CMR) for detecting hemodynamically significant stenosis causing a myocardial perfusion defect. Forty patients (30 men; mean age, 63.4 ± 8.8 years) with known or suspected coronary artery disease detected by CCTA underwent stress- and rest-DECT, CMR, and ICA. DECT iodine maps were compared with CMR on a per-segment and per-vessel basis. Diagnostic value of CCTA was assessed on a per-vessel basis before and after stress- and rest-DECT and compared to that of ICA/CMR. Compared to CMR, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of rest-DECT for detecting segment (vessel)-based perfusion defects were 29% (46%), 88% (79%), 56% (61%), and 70% (67%), respectively. Corresponding values using stress-DECT were 73% (94%), 83% (74%), 70% (72%), and 85% (95%), respectively. There was fair (κ = 0.39) agreement between rest- and stress-DECT iodine maps in identifying segments with perfusion defects. Compared with the ICA/CMR for identifying hemodynamically significant stenoses, per-vessel territory sensitivity, specificity, PPV, and NPV of CCTA were 91, 56, 55, and 91%, respectively; those using CCTA/rest-DECT were 42, 83, 59, and 70%, respectively; and those using CCTA/stress-DECT were 87, 79, 71, and 91%, respectively. The area under the receiver operating characteristic curve decreased from 0.74 to 0.62 (P = 0.06) using CCTA/rest-DECT but increased to 0.83 (P = 0.02) using CCTA/stress-DECT. Stress-DECT has incremental value when used with CCTA for detecting hemodynamically significant stenoses.
我们评估了压力和休息双能 CT（DECT）的诊断性能，以及在与 CCTA 联合使用时与联合侵入性冠状动脉造影（ICA）/心血管磁共振（CMR）相比检测导致心肌灌注缺损的有意义的狭窄的增量价值。40 名（30 名男性；平均年龄，63.4 ± 8.8 岁）通过 CCTA 检测到已知或疑似冠状动脉疾病的患者接受了压力和休息 DECT、CMR 和 ICA 检查。DECT 碘图与 CMR 按节段和血管进行比较。根据血管进行 CCTA 的诊断价值在压力和休息 DECT 前后进行评估，并与 ICA/CMR 进行比较。与 CMR 相比，休息 DECT 检测节段（血管）基础灌注缺损的敏感性、特异性、阳性预测值（PPV）和阴性预测值（NPV）分别为 29%（46%）、88%（79%）、56%（61%）和 70%（67%）。使用压力 DECT 的相应值分别为 73%（94%）、83%（74%）、70%（72%）和 85%（95%）。休息和压力 DECT 碘图在识别灌注缺损节段方面存在适度（κ=0.39）一致性。与 ICA/CMR 相比，用于识别有意义的狭窄的 CCTA 血管区域的敏感性、特异性、PPV 和 NPV 分别为 91%、56%、55%和 91%；使用 CCTA/rest-DECT 分别为 42%、83%、59%和 70%；使用 CCTA/stress-DECT 分别为 87%、79%、71%和 91%。使用 CCTA/rest-DECT 时，受试者工作特征曲线下面积从 0.74 降至 0.62（P=0.06），而使用 CCTA/stress-DECT 时则增至 0.83（P=0.02）。压力 DECT 与 CCTA 联合使用时对检测有意义的狭窄具有增量价值。
