Osawa Kazuhiro, Miyoshi Toru, Miki Takashi, Koyama Yasushi, Sato Shuhei, Kanazawa Susumu, Ito Hiroshi
Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan.
Department of Cardiology, Sakurabashi Watanabe Hospital, Osaka, Japan.
PLoS One. 2016 Feb 19;11(2):e0149170. doi: 10.1371/journal.pone.0149170. eCollection 2016.
Coronary computed tomography angiography (CCTA) in combination with first-pass CT myocardial perfusion imaging (MPI) has a better diagnostic performance than CCTA alone, compared with invasive coronary angiography as the reference standard. The aim of this study was to investigate the additional diagnostic value of first-pass CT-MPI without stress for detecting hemodynamic significance of coronary stenosis, compared with invasive fractional flow reserve (FFR). We recruited 53 patients with suspected coronary artery disease undergoing both CCTA and first-pass CT-MPI without stress and invasive FFR, and 75 vessels were analyzed. We used the same raw data for CCTA and CT-MPI. First-pass CT-MPI was reconstructed by examining the diastolic signal densities as a bull's eye map. Invasive FFR <0.8 was considered as positive. On per-vessel analysis, the area under the receiver operating characteristic curve for CCTA plus first-pass CT-MPI and CCTA alone was 0.81 (0.73-0.90) and 0.70 (0.61-0.81), respectively (P = 0.036). CCTA plus first-pass CT-MPI without stress showed 0.73 sensitivity, 0.74 specificity, 0.53 positive predictive value, and 0.87 negative predictive value for detecting hemodynamically significant coronary stenosis. First-pass CT-MPI without stress correctly reclassified 38% of CCTA false-positive vessels as true negative. First-pass CT-MPI without stress combined with CCTA demonstrated excellent diagnostic accuracy, compared with invasive FFR as the reference standard. This technique could complement CCTA for diagnosis of coronary artery disease.
与侵入性冠状动脉造影作为参考标准相比，冠状动脉计算机断层扫描血管造影（CCTA）联合首次通过CT心肌灌注成像（MPI）的诊断性能优于单独的CCTA。本研究的目的是探讨与侵入性血流储备分数（FFR）相比，静息状态下首次通过CT-MPI检测冠状动脉狭窄血流动力学意义的额外诊断价值。我们招募了53例疑似冠心病患者，这些患者同时接受了CCTA、静息状态下首次通过CT-MPI和侵入性FFR检查，并对75支血管进行了分析。CCTA和CT-MPI使用相同的原始数据。首次通过CT-MPI通过检查舒张期信号密度重建为靶心图。侵入性FFR<0.8被视为阳性。在每支血管分析中，CCTA加首次通过CT-MPI和单独CCTA的受试者操作特征曲线下面积分别为0.81（0.73-0.90）和0.70（0.61-0.81）（P=0.036）。静息状态下CCTA加首次通过CT-MPI检测血流动力学显著冠状动脉狭窄的灵敏度为0.73，特异度为0.74，阳性预测值为0.53，阴性预测值为0.87。静息状态下首次通过CT-MPI将38%的CCTA假阳性血管正确重新分类为真阴性。与侵入性FFR作为参考标准相比，静息状态下首次通过CT-MPI联合CCTA显示出优异的诊断准确性。该技术可作为CCTA诊断冠心病的补充手段。
