冠状动脉计算机断层扫描血管造影定量不良斑块特征与13N-氨正电子发射断层扫描下游心肌血流储备受损之间的关系：一项初步研究。
Relationship Between Quantitative Adverse Plaque Features From Coronary Computed Tomography Angiography and Downstream Impaired Myocardial Flow Reserve by 13N-Ammonia Positron Emission Tomography: A Pilot Study.
作者信息
Dey Damini, Diaz Zamudio Mariana, Schuhbaeck Annika, Juarez Orozco Luis Eduardo, Otaki Yuka, Gransar Heidi, Li Debiao, Germano Guido, Achenbach Stephan, Berman Daniel S, Meave Aloha, Alexanderson Erick, Slomka Piotr J
机构信息
From the Biomedical Imaging Research Institute (D.D., D.L.) and Department of Imaging and Medicine (M.D.Z., Y.O., H.G., G.G., D.S.B., P.J.S.), Cedars-Sinai Medical Center, Los Angeles, CA; Department of Cardiology, University of Erlangen, Erlangen, Germany (A.S., S.A.); Departments of Nuclear Cardiology (E.A., L.E.J.O.) and Cardiac Magnetic Resonance Department (A.M.), Instituto Nacional de Cardiologia Ignacio Chavez, Mexico, DF, Mexico; and Unidad PET/CT Ciclotron Facultad de Medicina UNAM, Mexico, DF, Mexico (E.A.).
出版信息
Circ Cardiovasc Imaging. 2015 Oct;8(10):e003255. doi: 10.1161/CIRCIMAGING.115.003255.
BACKGROUND
We investigated the relationship of quantitative plaque features from coronary computed tomography (CT) angiography and coronary vascular dysfunction by impaired myocardial flow reserve (MFR) by (13)N-Ammonia positron emission tomography (PET).
METHODS AND RESULTS
Fifty-one patients (32 men, 62.4±9.5 years) underwent combined rest-stress (13)N-ammonia PET and CT angiography scans by hybrid PET/CT. Regional MFR was measured from PET. From CT angiography, 153 arteries were evaluated by semiautomated software, computing arterial noncalcified plaque (NCP), low-density NCP (NCP<30 HU), calcified and total plaque volumes, and corresponding plaque burden (plaque volumex100%/vessel volume), stenosis, remodeling index, contrast density difference (maximum difference in luminal attenuation per unit area in the lesion), and plaque length. Quantitative stenosis, plaque burden, and myocardial mass were combined by boosted ensemble machine-learning algorithm into a composite risk score to predict impaired MFR (MFR≤2.0) by PET in each artery. Nineteen patients had impaired regional MFR in at least 1 territory (41/153 vessels). Patients with impaired regional MFR had higher arterial NCP (32.4% versus 17.2%), low-density NCP (7% versus 4%), and total plaque burden (37% versus 19.3%, P<0.02). In multivariable analysis with 10-fold cross-validation, NCP burden was the most significant predictor of impaired MFR (odds ratio, 1.35; P=0.021 for all). For prediction of impaired MFR with 10-fold cross-validation, receiver operating characteristics area under the curve for the composite score was 0.83 (95% confidence interval, 0.79-0.91) greater than for quantitative stenosis (0.66, 95% confidence interval, 0.57-0.76, P=0.005).
CONCLUSIONS
Compared with stenosis, arterial NCP burden and a composite score combining quantitative stenosis and plaque burden from CT angiography significantly improves identification of downstream regional vascular dysfunction.
背景
我们通过（13）N-氨正电子发射断层扫描（PET）评估心肌血流储备（MFR）受损情况，研究冠状动脉计算机断层扫描（CT）血管造影的定量斑块特征与冠状动脉血管功能障碍之间的关系。
方法与结果
51例患者（32例男性，年龄62.4±9.5岁）接受了静息-负荷联合（13）N-氨PET及CT血管造影扫描，采用PET/CT一体机。从PET测量局部MFR。通过半自动软件对CT血管造影的153条动脉进行评估，计算动脉非钙化斑块（NCP）、低密度NCP（NCP<30 HU）、钙化斑块和总斑块体积，以及相应的斑块负荷（斑块体积×100%/血管体积）、狭窄程度、重塑指数、对比剂密度差异（病变处单位面积管腔衰减的最大差异）和斑块长度。通过增强集成机器学习算法将定量狭窄、斑块负荷和心肌质量组合成一个综合风险评分，以预测每条动脉PET显示的MFR受损（MFR≤2.0）情况。19例患者至少有1个区域的局部MFR受损（41/153条血管）。局部MFR受损的患者动脉NCP更高（32.4%对17.2%）、低密度NCP更高（7%对4%）、总斑块负荷更高（37%对19.3%，P<0.02）。在10倍交叉验证的多变量分析中，NCP负荷是MFR受损的最显著预测因素（比值比，1.35；P=0.021）。对于10倍交叉验证预测MFR受损情况，综合评分的受试者工作特征曲线下面积为0.83（95%置信区间，0.79-0.91），高于定量狭窄的曲线下面积（0.66，95%置信区间，0.57-0.76，P=0.005）。
结论
与狭窄相比，动脉NCP负荷以及结合CT血管造影定量狭窄和斑块负荷的综合评分能显著提高对下游局部血管功能障碍的识别。
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