心肌 CT 灌注成像与 SPECT 诊断冠状动脉疾病：来自 CORE320 多中心诊断性能研究的头对头比较。
Myocardial CT perfusion imaging and SPECT for the diagnosis of coronary artery disease: a head-to-head comparison from the CORE320 multicenter diagnostic performance study.
机构信息
From the School of Medicine, Johns Hopkins University, 600 N Wolfe St, Blalock 524D2, Baltimore, MD 21287 (R.T.G., V.C.M., A.A.Z., J.M.M., A.L.V., J.A.C.L.); Department of Epidemiology, Bloomberg School of Public Health, Baltimore, Md (M.B.M., C.C.); Department of Nuclear Medicine and Cardiovascular Imaging, Brigham and Women's Hospital, Boston, Mass (M.D.C.); Department of Cardiology, Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil (C.E.R.); National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, Md (V.C.M., M.Y.C.); Department of Radiology, Iwate Medical University, Morioka, Japan (H.N.); Department of Radiology, St. Luke's International Hospital, Tokyo, Japan (H.N.); Department of Radiology, Mie University Hospital, Tsu, Japan (K.K.); Department of Radiology, Beth Israel Deaconess Medical Center, Harvard University, Boston, MA (M.E.C.); Department of Radiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark (K.F.K.); Department of Cardiology, National Heart Center, Singapore, Singapore (T.S.Y.); and Departments of Radiology (M.D.C.) and Nuclear Medicine (W.B.), Charité-University Medicine Berlin, Berlin, Germany.
出版信息
Radiology. 2014 Aug;272(2):407-16. doi: 10.1148/radiol.14140806. Epub 2014 May 26.
PURPOSE
To compare the diagnostic performance of myocardial computed tomographic (CT) perfusion imaging and single photon emission computed tomography (SPECT) perfusion imaging in the diagnosis of anatomically significant coronary artery disease (CAD) as depicted at invasive coronary angiography.
MATERIALS AND METHODS
This study was approved by the institutional review board. Written informed consent was obtained from all patients. Sixteen centers enrolled 381 patients from November 2009 to July 2011. Patients underwent rest and adenosine stress CT perfusion imaging and rest and either exercise or pharmacologic stress SPECT before and within 60 days of coronary angiography. Images from CT perfusion imaging, SPECT, and coronary angiography were interpreted at blinded, independent core laboratories. The primary diagnostic parameter was the area under the receiver operating characteristic curve (Az). Sensitivity and specificity were calculated with use of prespecified cutoffs. The reference standard was a stenosis of at least 50% at coronary angiography as determined with quantitative methods.
RESULTS
CAD was diagnosed in 229 of the 381 patients (60%). The per-patient sensitivity and specificity for the diagnosis of CAD (stenosis ≥50%) were 88% (202 of 229 patients) and 55% (83 of 152 patients), respectively, for CT perfusion imaging and 62% (143 of 229 patients) and 67% (102 of 152 patients) for SPECT, with Az values of 0.78 (95% confidence interval: 0.74, 0.82) and 0.69 (95% confidence interval: 0.64, 0.74) (P = .001). The sensitivity of CT perfusion imaging for single- and multivessel CAD was higher than that of SPECT, with sensitivities for left main, three-vessel, two-vessel, and one-vessel disease of 92%, 92%, 89%, and 83%, respectively, for CT perfusion imaging and 75%, 79%, 68%, and 41%, respectively, for SPECT.
CONCLUSION
The overall performance of myocardial CT perfusion imaging in the diagnosis of anatomic CAD (stenosis ≥50%), as demonstrated with the Az, was higher than that of SPECT and was driven in part by the higher sensitivity for left main and multivessel disease.
目的
比较心肌计算机断层（CT）灌注成像和单光子发射计算机断层（SPECT）灌注成像在诊断经侵入性冠状动脉造影（CAG）显示的解剖学上有意义的冠状动脉疾病（CAD）方面的诊断性能。
材料和方法
本研究经机构审查委员会批准。所有患者均签署书面知情同意书。2009 年 11 月至 2011 年 7 月，16 个中心共纳入 381 例患者。患者在 CAG 前 60 天内行静息和腺苷负荷 CT 灌注成像以及静息和运动或药物负荷 SPECT 检查。CT 灌注成像、SPECT 和 CAG 图像由独立的核心实验室进行盲法解读。主要诊断参数为受试者工作特征曲线下面积（Az）。使用预设的截断值计算灵敏度和特异性。参考标准为定量 CAG 显示的至少 50%狭窄。
结果
381 例患者中有 229 例（60%）诊断为 CAD。CT 灌注成像诊断 CAD（狭窄≥50%）的患者敏感性和特异性分别为 88%（229 例患者中的 202 例）和 55%（152 例患者中的 83 例），SPECT 分别为 62%（229 例患者中的 143 例）和 67%（152 例患者中的 102 例），Az 值分别为 0.78（95%置信区间：0.74，0.82）和 0.69（95%置信区间：0.64，0.74）（P=0.001）。CT 灌注成像诊断单支和多支 CAD 的敏感性高于 SPECT，左主干、三支血管、两支血管和一支血管病变的敏感性分别为 92%、92%、89%和 83%，SPECT 分别为 75%、79%、68%和 41%。
结论
Az 所示，心肌 CT 灌注成像在诊断解剖学 CAD（狭窄≥50%）方面的整体性能优于 SPECT，这在一定程度上是由于对左主干和多支血管疾病的敏感性更高所致。
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