Department of Medical Imaging, Jinan Military General Hospital, Jinan, Shandong Province, China.
Department of Medical Imaging, Jinan Military General Hospital, Jinan, Shandong Province, China.
JACC Cardiovasc Imaging. 2014 Nov;7(11):1098-105. doi: 10.1016/j.jcmg.2014.07.011. Epub 2014 Oct 8.
This paper systematically analyzed the performance of magnetic resonance (MR) perfusion to diagnose coronary artery disease (CAD) with fractional flow reserve (FFR) as the reference standard.
Myocardial MR perfusion has passed the stage of a research technique and has demonstrated the ability to detect functional or ischemic stenosis of coronary arteries. However, the evidence is limited to single-center studies and small sample sizes.
We searched PubMed and Embase databases for all published studies that evaluated the accuracy of MR perfusion to diagnose CAD versus FFR. We used an exact binomial rendition of the bivariate mixed-effects regression model with test type as a random-effects covariate to synthesize the available data. Based on Bayes' theorem, the post-test probability was calculated to guide MR perfusion's clinical utility.
We identified 14 studies evaluating 1,073 arteries and 650 patients. The pooled sensitivity and specificity were 0.90 (95% confidence interval [CI]: 0.86 to 0.93) and 0.87 (95% CI: 0.82 to 0.90) at the patient level and 0.89 (95% CI: 0.83 to 0.92) and 0.86 (95% CI: 0.77 to 0.92) at the artery and territory levels, respectively. The area under the summary receiver-operating characteristic at the patient level was 0.95 (95% CI: 0.92 to 0.96) and 0.93 (95% CI: 0.91 to 0.95) at the artery and territory levels, respectively. MR perfusion could increase the post-test probability of CAD >80% in patients with a pre-test probability of >37% and can decrease post-test probability of CAD <20% with a pre-test probability of <72%.
With FFR as the reference standard, the diagnostic ability of MR perfusion to detect ischemic CAD is high.
本文系统分析了磁共振（MR）灌注成像以血流储备分数（FFR）为参照标准诊断冠状动脉疾病（CAD）的性能。
心肌 MR 灌注已通过研究技术阶段，能够检测冠状动脉的功能性或缺血性狭窄。然而，证据仅限于单中心研究和小样本量。
我们检索了 PubMed 和 Embase 数据库，以评估所有评估 MR 灌注诊断 CAD 与 FFR 准确性的研究。我们使用二元混合效应回归模型的精确二项式演绎，以测试类型为随机效应协变量，综合可用数据。根据贝叶斯定理，计算了后验概率以指导 MR 灌注的临床实用性。
我们确定了 14 项评估 1073 支血管和 650 例患者的研究。在患者水平，汇总的敏感度和特异度分别为 0.90（95%置信区间：0.86 至 0.93）和 0.87（95%置信区间：0.82 至 0.90），在血管和区域水平分别为 0.89（95%置信区间：0.83 至 0.92）和 0.86（95%置信区间：0.77 至 0.92）。在患者水平的汇总受试者工作特征曲线下面积分别为 0.95（95%置信区间：0.92 至 0.96）和 0.93（95%置信区间：0.91 至 0.95）。在患者预测试概率为 >37%且 CAD>80%的情况下，MR 灌注可以增加后测试概率；而在患者预测试概率为 <72%且 CAD<20%的情况下，MR 灌注可以降低后测试概率。
以 FFR 为参照标准，MR 灌注检测缺血性 CAD 的诊断能力较高。
