混合心脏成像方法评估阻塞性冠状动脉疾病与单独冠状动脉计算机断层血管造影的诊断性能比较的荟萃分析。
Diagnostic Performance of Hybrid Cardiac Imaging Methods for Assessment of Obstructive Coronary Artery Disease Compared With Stand-Alone Coronary Computed Tomography Angiography: A Meta-Analysis.
机构信息
Dalio Institute of Cardiovascular Imaging, Department of Radiology, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, New York; Department of Radiology, Mayo Clinic, Rochester, Minnesota.
Dalio Institute of Cardiovascular Imaging, Department of Radiology, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, New York; Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, South Korea.
出版信息
JACC Cardiovasc Imaging. 2018 Apr;11(4):589-599. doi: 10.1016/j.jcmg.2017.05.020. Epub 2017 Aug 16.
OBJECTIVES
The current meta-analysis aimed to evaluate the diagnostic performance of hybrid cardiac imaging techniques compared with stand-alone coronary computed tomography angiography (CTA) for assessment of obstructive coronary artery disease (CAD).
BACKGROUND
The usefulness of coronary CTA for detecting obstructive CAD remains suboptimal at present. Myocardial perfusion imaging encompasses positron emission tomography, single-photon emission computed tomography, and cardiac magnetic resonance, which permit the identification of myocardial perfusion defects to detect significant CAD. A hybrid approach comprising myocardial perfusion imaging and coronary CTA may improve diagnostic performance for detecting obstructive CAD.
METHODS
PubMed and Web of Knowledge were searched for relevant publications between January 1, 2000 and December 31, 2015. Studies using coronary CTA and hybrid imaging for diagnosis of obstructive CAD (a luminal diameter reduction of >50% or >70% by invasive coronary angiography) were included. In total, 12 articles comprising 951 patients and 1,973 vessels were identified, and a meta-analysis was performed to determine pooled sensitivity, specificity, and summary receiver-operating characteristic curves.
RESULTS
On a per-patient basis, the pooled sensitivity of hybrid imaging was comparable to that of coronary CTA (91% vs. 90%; p = 0.28). However, specificity was higher for hybrid imaging versus coronary CTA (93% vs. 66%; p < 0.001). On a per-vessel basis, sensitivity for hybrid imaging against coronary CTA was comparable (84% vs. 89%; p = 0.29). Notably, hybrid imaging yielded a specificity of 95% versus 83% for coronary CTA (p < 0.001). Summary receiver-operating characteristic curves displayed improved discrimination for hybrid imaging beyond coronary CTA alone, on a per-vessel basis (area under the curve: 0.97 vs. 0.93; p = 0.047), although not on a per-patient level (area under the curve: 0.97 vs. 0.93; p = 0.132).
CONCLUSIONS
Hybrid cardiac imaging demonstrated improved diagnostic specificity for detection of obstructive CAD compared with stand-alone coronary CTA, yet improvement in overall diagnostic performance was relatively limited.
目的
本荟萃分析旨在评估混合心脏成像技术与独立冠状动脉计算机断层扫描血管造影（CTA）相比，在评估阻塞性冠状动脉疾病（CAD）方面的诊断性能。
背景
目前，冠状动脉 CTA 检测阻塞性 CAD 的效用仍不理想。心肌灌注成像包括正电子发射断层扫描、单光子发射计算机断层扫描和心脏磁共振，这些方法可以识别心肌灌注缺陷，从而检测出有意义的 CAD。包含心肌灌注成像和冠状动脉 CTA 的混合方法可能会提高检测阻塞性 CAD 的诊断性能。
方法
在 2000 年 1 月 1 日至 2015 年 12 月 31 日期间，我们在 PubMed 和 Web of Knowledge 上搜索了相关文献。纳入了使用冠状动脉 CTA 和混合成像诊断阻塞性 CAD（管腔直径减少>50%或>70%的经导管冠状动脉造影）的研究。总共纳入了 12 篇文章，包括 951 例患者和 1973 个血管，进行了荟萃分析以确定汇总敏感性、特异性和汇总受试者工作特征曲线。
结果
基于每位患者，混合成像的汇总敏感性与冠状动脉 CTA 相当（91%比 90%；p=0.28）。然而，混合成像的特异性高于冠状动脉 CTA（93%比 66%；p<0.001）。基于每个血管，混合成像的敏感性与冠状动脉 CTA 相当（84%比 89%；p=0.29）。值得注意的是，混合成像的特异性为 95%，而冠状动脉 CTA 的特异性为 83%（p<0.001）。汇总受试者工作特征曲线显示，基于每个血管，混合成像的鉴别力优于单独的冠状动脉 CTA（曲线下面积：0.97 比 0.93；p=0.047），尽管在每位患者水平上并非如此（曲线下面积：0.97 比 0.93；p=0.132）。
结论
与独立冠状动脉 CTA 相比，混合心脏成像在检测阻塞性 CAD 方面表现出了更高的诊断特异性，但总体诊断性能的提高相对有限。
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