压力心肌灌注成像与有创冠状动脉造影术伴血流储备分数的荟萃分析比较的诊断准确性。
Diagnostic accuracy of stress myocardial perfusion imaging compared to invasive coronary angiography with fractional flow reserve meta-analysis.
机构信息
From the Departments of Radiology (R.A.P.T., B.A.B., H.E.A., J.H., P.A.d.J., T.L.) and Cardiology (H.E.A.), University Medical Center Utrecht, Utrecht, The Netherlands; Cardiac MR PET CT Program, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston (R.A.P.T., U.H.); and Division of Imaging Sciences and Biomedical Engineering, St. Thomas' Hospital, London, United Kingdom (E.N.).
出版信息
Circ Cardiovasc Imaging. 2015 Jan;8(1). doi: 10.1161/CIRCIMAGING.114.002666.
BACKGROUND
Hemodynamically significant coronary artery disease is an important indication for revascularization. Stress myocardial perfusion imaging is a noninvasive alternative to invasive fractional flow reserve for evaluating hemodynamically significant coronary artery disease. The aim was to determine the diagnostic accuracy of myocardial perfusion imaging by single-photon emission computed tomography, echocardiography, MRI, positron emission tomography, and computed tomography compared with invasive coronary angiography with fractional flow reserve for the diagnosis of hemodynamically significant coronary artery disease.
METHODS AND RESULTS
The meta-analysis adhered to the Preferred Reporting Items for Systematic Reviews and Meta-analyses statement. PubMed, EMBASE, and Web of Science were searched until May 2014. Thirty-seven studies, reporting on 4721 vessels and 2048 patients, were included. Meta-analysis yielded pooled sensitivity, pooled specificity, pooled likelihood ratios (LR), pooled diagnostic odds ratio, and summary area under the receiver operating characteristic curve. The negative LR (NLR) was chosen as the primary outcome. At the vessel level, MRI (pooled NLR, 0.16; 95% confidence interval [CI], 0.13-0.21) was performed similar to computed tomography (pooled NLR, 0.22; 95% CI, 0.12-0.39) and positron emission tomography (pooled NLR, 0.15; 95% CI, 0.05-0.44), and better than single-photon emission computed tomography (pooled NLR, 0.47; 95% CI, 0.37-0.59). At the patient level, MRI (pooled NLR, 0.14; 95% CI, 0.10-0.18) performed similar to computed tomography (pooled NLR, 0.12; 95% CI, 0.04-0.33) and positron emission tomography (pooled NLR, 0.14; 95% CI, 0.02-0.87), and better than single-photon emission computed tomography (pooled NLR, 0.39; 95% CI, 0.27-0.55) and echocardiography (pooled NLR, 0.42; 95% CI, 0.30-0.59).
CONCLUSIONS
Stress myocardial perfusion imaging with MRI, computed tomography, or positron emission tomography can accurately rule out hemodynamically significant coronary artery disease and can act as a gatekeeper for invasive revascularization. Single-photon emission computed tomography and echocardiography are less suited for this purpose.
背景
血流动力学显著的冠状动脉疾病是血运重建的重要指征。应激心肌灌注成像（MPI）是一种替代有创血流储备分数（FFR）评估血流动力学显著的冠状动脉疾病的非侵入性方法。本研究旨在确定单光子发射计算机断层扫描（SPECT）、超声心动图、磁共振成像（MRI）、正电子发射断层扫描（PET）和计算机断层扫描（CT）MPI 相对于有创冠状动脉造影和 FFR 对血流动力学显著的冠状动脉疾病的诊断准确性。
方法
本荟萃分析符合系统评价和荟萃分析的首选报告项目声明。检索 PubMed、EMBASE 和 Web of Science 直至 2014 年 5 月。纳入了 37 项研究，共计 4721 支血管和 2048 例患者。荟萃分析得出了汇总敏感性、汇总特异性、汇总似然比（LR）、汇总诊断优势比和受试者工作特征曲线下面积。选择负似然比（NLR）作为主要结局。在血管水平，MRI（汇总 NLR，0.16；95%置信区间[CI]，0.13-0.21）与 CT（汇总 NLR，0.22；95%CI，0.12-0.39）和 PET（汇总 NLR，0.15；95%CI，0.05-0.44）表现相似，优于 SPECT（汇总 NLR，0.47；95%CI，0.37-0.59）。在患者水平，MRI（汇总 NLR，0.14；95%CI，0.10-0.18）与 CT（汇总 NLR，0.12；95%CI，0.04-0.33）和 PET（汇总 NLR，0.14；95%CI，0.02-0.87）表现相似，优于 SPECT（汇总 NLR，0.39；95%CI，0.27-0.55）和超声心动图（汇总 NLR，0.42；95%CI，0.30-0.59）。
结论
MPI 中的 MRI、CT 或 PET 可以准确排除血流动力学显著的冠状动脉疾病，并可作为有创血运重建的筛选手段。SPECT 和超声心动图不太适合用于此目的。
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