Barts and the London School of Medicine and Dentistry, Queen Mary University of London, Garrod Building, Turner Street, London E1 2AD, UK.
NIHR Cardiovascular Biomedical Research Unit at Barts, William Harvey Research Institute, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, UK.
Eur Heart J Cardiovasc Imaging. 2017 Nov 1;18(11):1216-1221. doi: 10.1093/ehjci/jew205.
Adenosine can induce splenic vasoconstriction (splenic switch-off, SSO). In this study, we aim to evaluate the utility of identifying a lack of SSO for detecting false-negative adenosine stress perfusion cardiac magnetic resonance (CMR) scans.
We visually analysed 492 adenosine stress perfusion CMR scans reported as negative in a cohort of patients with no previous history of coronary artery disease. A lack of SSO was identified in 11%. We quantified the phenomenon by drawing regions of interest on the spleen and comparing intensity between stress and rest scans, the spleen intensity ratio (SIR). Inter-rater agreement for qualitative determination of SSO was κ = 0.81 and inter-class correlation for quantitative determination of SSO was 0.94. The optimal threshold for SIR as an indicator of SSO was 0.40 (sensitivity = 82.5%, specificity = 92.3%, AUC = 0.91). 23 065 CMR scans and 9926 invasive coronary angiogram reports were retrospectively examined to identify patients with negative CMR scans who required coronary intervention in the subsequent 12 months (false negatives). We compared these scans with true positives who had positive adenosine stress perfusion CMR scans followed by coronary intervention. The rate of lack of SSO was 20.7% in the false-negative group versus 13.1% in true positives (P = 0.37).
The lack of SSO is prevalent, easily measureable, and has potential to improve on haemodynamic criteria as a marker of adenosine understress in CMR perfusion scans.
腺嘌呤能诱导脾脏血管收缩（脾脏关闭，SSO）。本研究旨在评估识别 SSO 缺失在检测腺苷应激灌注心脏磁共振（CMR）扫描假阴性中的作用。
我们对无冠心病既往史患者队列中报告为阴性的 492 例腺苷应激灌注 CMR 扫描进行了视觉分析。11%的患者缺乏 SSO。我们通过在脾脏上绘制感兴趣区域并比较应激和休息扫描之间的强度来量化这种现象，即脾脏强度比（SIR）。SSO 定性判断的观察者间一致性为 κ = 0.81，SSO 定量判断的组间相关性为 0.94。作为 SSO 指标的 SIR 最佳阈值为 0.40（敏感性=82.5%，特异性=92.3%，AUC=0.91）。回顾性检查了 23065 次 CMR 扫描和 9926 次血管造影报告，以确定在随后 12 个月内需要冠状动脉介入治疗的阴性 CMR 扫描患者（假阴性）。我们将这些扫描与阳性腺苷应激灌注 CMR 扫描后进行冠状动脉介入治疗的真阳性患者进行了比较。假阴性组 SSO 缺失率为 20.7%，真阳性组为 13.1%（P=0.37）。
SSO 缺失很常见，易于测量，并且有可能改善 CMR 灌注扫描中作为腺苷应激标记物的血流动力学标准。
