Wichmann Julian L, Meinel Felix G, Schoepf U Joseph, Lo Gladys G, Choe Yeon Hyeon, Wang Yining, Vliegenthart Rozemarijn, Varga-Szemes Akos, Muscogiuri Giuseppe, Cannaò Paola M, De Cecco Carlo N
1 Department of Radiology and Radiological Science, Medical University of South Carolina, Ashley River Tower, 25 Courtenay Dr, MSC 226, Charleston, SC 29425.
2 Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt, Germany.
AJR Am J Roentgenol. 2015 Jul;205(1):W67-72. doi: 10.2214/AJR.14.14087.
The purpose of this study was to evaluate differences in the diagnostic accuracy of absolute and relative territorial myocardial blood flow (MBF) derived from stress dynamic CT myocardial perfusion imaging (MPI) for the detection of significant coronary artery stenosis.
Dynamic CT MPI and coronary CT angiography (CTA) datasets from a multicenter registry of 137 patients (mean age, 60.9 ± 8.4 years; 88 men) with suspected or known coronary artery disease were retrospectively analyzed. For each coronary territory, absolute MBF and the MBF relative to remote myocardium (MBF ratio) were calculated. Coronary CTA datasets were visually assessed for significant stenosis (≥ 50% luminal narrowing) in consensus by two observers.
Significant stenosis was detected in 137 of 411 (33.3%) vessels. Mean absolute MBF and MBF ratio were statistically significantly lower in territories supplied by arteries with stenosis (80.7 ± 33.7 vs 140.0 ± 38.4 mL/100 mL/min and 0.52 vs 0.89, respectively; both p < 0.0001). ROC analysis showed better discrimination by MBF ratio than by absolute MBF (AUC, 0.925 vs 0.882; p = 0.0022) and increased sensitivity (90.7% vs 82.4%; p < 0.04) and specificity (93.1% vs 80.5%; p < 0.03) for MBF ratio and absolute MBF cutoff values of 0.71 or less and 103 mL/100 mL/min or less, respectively.
In stress dynamic CT MPI, relative MBF provides superior diagnostic accuracy compared with absolute territorial MBF values for coronary CTA-detected significant coronary artery stenosis.
本研究旨在评估应激动态CT心肌灌注成像（MPI）得出的绝对和相对心肌血流（MBF）在检测显著冠状动脉狭窄时诊断准确性的差异。
回顾性分析了来自一个多中心登记处的137例（平均年龄60.9±8.4岁；88例男性）疑似或已知冠状动脉疾病患者的动态CT MPI和冠状动脉CT血管造影（CTA）数据集。对于每个冠状动脉区域，计算绝对MBF和相对于远隔心肌的MBF（MBF比值）。由两名观察者共同对冠状动脉CTA数据集进行显著狭窄（管腔狭窄≥50%）的视觉评估。
在411支血管中的137支（33.3%）检测到显著狭窄。狭窄动脉供血区域的平均绝对MBF和MBF比值在统计学上显著更低（分别为80.7±33.7 vs 140.0±38.4 mL/100 mL/min和0.52 vs 0.89；两者p<0.0001）。ROC分析显示，MBF比值比绝对MBF具有更好的鉴别能力（AUC，0.925 vs 0.882；p=0.0022），对于MBF比值和绝对MBF，当截断值分别为0.71或更低以及103 mL/100 mL/min或更低时，敏感性增加（90.7% vs 82.4%；p<0.04），特异性增加（93.1% vs 80.5%；p<0.03）。
在应激动态CT MPI中，与绝对心肌血流值相比，相对MBF对冠状动脉CTA检测到的显著冠状动脉狭窄具有更高的诊断准确性。
