Rodriguez-Granillo Gaston A, Campisi Roxana, Deviggiano Alejandro, de Munain Maria N Lopez, Zan Macarena De, Capunay Carlos, Carrascosa Patricia
1 Department of Cardiovascular Imaging, Diagnóstico Maipú, Avenue Maipu 1668, Buenos Aires B1602BQ, Argentina.
AJR Am J Roentgenol. 2017 Nov;209(5):1023-1032. doi: 10.2214/AJR.17.18118. Epub 2017 Aug 31.
The objective of our study was to explore whether delayed enhancement dual-energy CT (DECT) allows the detection of myocardial infarcts in stable patients.
Patients with known or suspected coronary artery disease clinically referred for myocardial perfusion imaging using SPECT were prospectively included. All patients (n = 34) also underwent stress, rest, and delayed enhancement DECT on a DECT scanner. At SPECT, segments with myocardial infarction (MI) were defined as those with a summed rest score of ≥ 2 in two or more consecutive segments, and a diagnosis of MI was supported by wall motion abnormalities, clinical history, and ECG findings.
Segments with MI were identified in 13 (38%), 15 (44%), and 14 (41%) patients using SPECT, perfusion CT, and delayed enhancement DECT, respectively. When combined SPECT and perfusion CT results were used as the reference standard, delayed enhancement DECT had a sensitivity, specificity, positive predictive value, and negative predictive value for the detection of MI of 91.7% (95% CI, 62-98%), 86.4% (95% CI, 65-97%), 78.6% (95% CI, 49-95%), and 95.0% (95% CI, 75-100%). At delayed enhancement DECT (40 keV), a signal attenuation higher than 161 HU had a sensitivity of 72% and a specificity of 79% for the detection of MI on a per-segment basis. The median signal attenuation of myocardial infarcts at 40 keV was 3.0 SDs (interquartile range, 1.3-4.0 SDs) above that of normal myocardium.
In this study, delayed enhancement DECT allowed the detection of myocardial infarcts in stable patients.
本研究的目的是探讨延迟增强双能CT（DECT）是否能够检测稳定期患者的心肌梗死。
前瞻性纳入临床上因已知或疑似冠状动脉疾病而转诊进行单光子发射计算机断层扫描（SPECT）心肌灌注成像的患者。所有患者（n = 34）还在一台DECT扫描仪上接受了负荷、静息和延迟增强DECT检查。在SPECT检查中，心肌梗死（MI）节段定义为两个或更多连续节段静息积分总和≥2的节段，MI的诊断由室壁运动异常、临床病史和心电图结果支持。
分别使用SPECT、灌注CT和延迟增强DECT在13例（38%）、15例（44%）和14例（41%）患者中识别出MI节段。当联合使用SPECT和灌注CT结果作为参考标准时，延迟增强DECT检测MI的灵敏度、特异度、阳性预测值和阴性预测值分别为91.7%（95%CI，62 - 98%）、86.4%（95%CI，65 - 97%）、78.6%（95%CI，49 - 95%）和95.0%（95%CI，75 - 100%）。在延迟增强DECT（40 keV）检查中，信号衰减高于161 HU时，基于节段检测MI的灵敏度为72%，特异度为79%。40 keV时心肌梗死的中位信号衰减比正常心肌高3.0个标准差（四分位间距，1.3 - 4.0个标准差）。
在本研究中，延迟增强DECT能够检测稳定期患者的心肌梗死。
