计算机断层扫描联合冠状动脉造影和心肌灌注用于识别血流限制性狭窄——CORE320研究：CT冠状动脉造影与心肌灌注的综合分析
Combined coronary angiography and myocardial perfusion by computed tomography in the identification of flow-limiting stenosis - The CORE320 study: An integrated analysis of CT coronary angiography and myocardial perfusion.
作者信息
Magalhães Tiago A, Kishi Satoru, George Richard T, Arbab-Zadeh Armin, Vavere Andrea L, Cox Christopher, Matheson Matthew B, Miller Julie M, Brinker Jeffrey, Di Carli Marcelo, Rybicki Frank J, Rochitte Carlos E, Clouse Melvin E, Lima João A C
机构信息
Department of Cardiology, Cardiology Division, Johns Hopkins Hospital, Johns Hopkins University School of Medicine, Blalock 524D1, 600 North Wolfe Street, Baltimore, MD 21287, USA; Department of Cardiology, Heart Institute (InCor), University of São Paulo Medical School, Brazil; Department of Radiology, Division of Cardiovascular CT/MR, Heart Hospital (HCOR), São Paulo, Sao Paulo, Brazil.
Department of Cardiology, Cardiology Division, Johns Hopkins Hospital, Johns Hopkins University School of Medicine, Blalock 524D1, 600 North Wolfe Street, Baltimore, MD 21287, USA.
出版信息
J Cardiovasc Comput Tomogr. 2015 Sep-Oct;9(5):438-45. doi: 10.1016/j.jcct.2015.03.004. Epub 2015 Mar 21.
BACKGROUND
The combination of coronary CT angiography (CTA) and myocardial CT perfusion (CTP) is gaining increasing acceptance, but a standardized approach to be implemented in the clinical setting is necessary.
OBJECTIVES
To investigate the accuracy of a combined coronary CTA and myocardial CTP comprehensive protocol compared to coronary CTA alone, using a combination of invasive coronary angiography and single photon emission CT as reference.
METHODS
Three hundred eighty-one patients included in the CORE320 trial were analyzed in this study. Flow-limiting stenosis was defined as the presence of ≥50% stenosis by invasive coronary angiography with a related perfusion defect by single photon emission CT. The combined CTA + CTP definition of disease was the presence of a ≥50% stenosis with a related perfusion defect. All data sets were analyzed by 2 experienced readers, aligning anatomic findings by CTA with perfusion defects by CTP.
RESULTS
Mean patient age was 62 ± 6 years (66% male), 27% with prior history of myocardial infarction. In a per-patient analysis, sensitivity for CTA alone was 93%, specificity was 54%, positive predictive value was 55%, negative predictive value was 93%, and overall accuracy was 69%. After combining CTA and CTP, sensitivity was 78%, specificity was 73%, negative predictive value was 64%, positive predictive value was 0.85%, and overall accuracy was 75%. In a per-vessel analysis, overall accuracy of CTA alone was 73% compared to 79% for the combination of CTA and CTP (P < .0001 for difference).
CONCLUSIONS
Combining coronary CTA and myocardial CTP findings through a comprehensive protocol is feasible. Although sensitivity is lower, specificity and overall accuracy are higher than assessment by coronary CTA when compared against a reference standard of stenosis with an associated perfusion defect.
背景
冠状动脉CT血管造影（CTA）与心肌CT灌注（CTP）的联合应用越来越受到认可，但在临床环境中实施标准化方法是必要的。
目的
以有创冠状动脉造影和单光子发射CT的联合应用作为参考，研究冠状动脉CTA与心肌CTP综合方案与单独冠状动脉CTA相比的准确性。
方法
本研究分析了纳入CORE320试验的381例患者。血流限制性狭窄定义为有创冠状动脉造影显示狭窄≥50%且单光子发射CT显示相关灌注缺损。疾病的CTA + CTP联合定义为存在≥50%的狭窄且伴有相关灌注缺损。所有数据集由2名经验丰富的阅片者进行分析，将CTA的解剖学发现与CTP的灌注缺损进行比对。
结果
患者平均年龄为62±6岁（66%为男性），27%有心肌梗死病史。在患者层面分析中，单独CTA的敏感性为93%，特异性为54%，阳性预测值为55%，阴性预测值为93%，总体准确性为69%。CTA与CTP联合后，敏感性为78%，特异性为73%，阴性预测值为64%，阳性预测值为85%，总体准确性为75%。在血管层面分析中，单独CTA的总体准确性为73%，而CTA与CTP联合应用为79%（差异P <.0001）。
结论
通过综合方案结合冠状动脉CTA和心肌CTP的结果是可行的。尽管敏感性较低，但与伴有相关灌注缺损的狭窄参考标准相比，特异性和总体准确性高于冠状动脉CTA评估。
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