From the Department of Radiology (D.H.Y., J.W.K., D.H., N.K., T.H.L.), Research Institute of Radiology, Department of Cardiology (Y.H.K., J.H.R., J.J., J.M.A., J.Y.L., D.W.P., S.H.K., S.W.L., C.W.L., S.W.P., S.J.P.), and Heart Institute, Department of Clinical Epidemiology and Biostatistics (J.B.L.), Asan Medical Center, University of Ulsan College of Medicine, Asanbyeongwon-gil 86, Seoul 138-736, South Korea.
Radiology. 2015 Sep;276(3):715-23. doi: 10.1148/radiol.2015141126. Epub 2015 Apr 16.
To assess the diagnostic accuracy of stress myocardial perfusion computed tomography (CT) by using visual and quantitative analytic methods in patients with coronary artery disease, with fractional flow reserve (FFR) as a reference standard.
The institutional review board approved the study, and written informed consent was obtained from all patients. The diagnostic accuracy of myocardial perfusion CT was assessed for 75 patients who underwent myocardial perfusion CT and conventional coronary angiography with reference to hemodynamically significant stenosis, defined as the presence of an FFR of 0.8 or less or an angiographically severe (≥90%) stenosis. Results of quantitative analysis of myocardial perfusion CT data were compared with those of visual analysis by using areas under the receiver operating characteristic curve (AUCs).
Among the 75 patients and 210 epicardial arteries, 61 patients (81%) with 86 arteries (41%) had hemodynamically significant stenosis. The per-patient sensitivity and specificity of the visual assessment of myocardial perfusion CT data for all patients were 89% and 86%, respectively. At per-vessel analysis, the sensitivities and specificities, respectively, of myocardial perfusion CT were 80% and 95% for all vessels, 85% and 100% for 63 vessels with severe coronary calcification (defined as an Agatston score > 400), and 76% and 91% for 56 vessels in patients with multivessel disease. In severely calcified vessels, visual assessment of myocardial perfusion CT data in combination with CT angiography provided incremental value over CT angiography alone for the detection of myocardial ischemia (integrated discrimination improvement index, 0.38; P < .001). Quantitative assessment of transmural perfusion ratio had a lower AUC than visual analysis of myocardial perfusion CT (0.759 vs 0.877, P = .002).
Stress myocardial perfusion CT provides incremental value over CT angiography in patients with a high calcium score for the detection of myocardial ischemia as defined by FFR.
以血流储备分数（FFR）为参照标准，采用视觉和定量分析方法评估冠心病患者应激心肌灌注计算机断层扫描（CT）的诊断准确性。
本研究经机构审查委员会批准，并获得所有患者的书面知情同意。对 75 例接受心肌灌注 CT 和常规冠状动脉造影的患者进行了心肌灌注 CT 诊断准确性评估，参照存在血流动力学意义狭窄（定义为 FFR ＜ 0.8 或存在≥90%的严重狭窄）的情况。采用受试者工作特征曲线（AUC）下面积比较心肌灌注 CT 数据定量分析与视觉分析的结果。
在 75 例患者和 210 支心外膜动脉中，61 例（81%）患者的 86 支（41%）动脉存在血流动力学意义狭窄。所有患者的心肌灌注 CT 数据视觉评估的每位患者的敏感性和特异性分别为 89%和 86%。在血管水平分析中，所有血管的心肌灌注 CT 的敏感性和特异性分别为 80%和 95%、严重冠状动脉钙化（定义为 Agatston 评分＞400）的 63 支血管的敏感性和特异性分别为 85%和 100%、多支血管疾病的 56 支血管的敏感性和特异性分别为 76%和 91%。在严重钙化的血管中，与 CT 血管造影相比，心肌灌注 CT 数据的视觉评估结合 CT 血管造影在检测心肌缺血方面提供了附加价值（综合鉴别改善指数，0.38；P＜0.001）。透壁灌注比值的定量评估的 AUC 低于心肌灌注 CT 的视觉分析（0.759 比 0.877，P=0.002）。
对于以 FFR 定义的存在高钙分数的患者，应激心肌灌注 CT 在检测心肌缺血方面比 CT 血管造影提供了附加价值。
