Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands.
Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA.
Eur Radiol. 2018 Mar;28(3):1253-1256. doi: 10.1007/s00330-017-5057-8. Epub 2017 Sep 27.
The detection of functional coronary artery stenosis with coronary CT angiography (CCTA) is suboptimal. Additional CT myocardial perfusion imaging (CT-MPI) may be helpful to identify patients with myocardial ischaemia in whom coronary revascularization therapy would be beneficial. CT-MPI adds incremental diagnostic and prognostic value over obstructive disease on CCTA. It allows for the quantitation of myocardial blood flow and calculation of coronary flow reserve and shows good correlation with O-HO positron emission tomography and invasive fractional flow reserve. In addition, patients prefer CCTA/CT-MPI over SPECT, MRI and invasive coronary angiography. CT-MPI is ready for clinical use for detecting myocardial ischaemia caused by obstructive disease. Nevertheless, the clinical utility of CT-MPI to identify ischaemia in patients with non-obstructive/microvascular disease still has to be established.
• CT-MPI can improve the positive predictive value of CCTA for lesion-specific ischaemia. • CT-MPI adds incremental prognostic value over CCTA for major adverse cardiac events. • CT-MPI correlates with O-H O PET. • CT-MPI/CCTA shows high overall patient satisfaction.
冠状动脉 CT 血管造影术（CCTA）检测功能性冠状动脉狭窄的效果并不理想。额外的 CT 心肌灌注成像（CT-MPI）可能有助于识别有心肌缺血的患者，这些患者进行冠状动脉血运重建治疗将是有益的。CT-MPI 在 CCTA 上的阻塞性疾病的基础上增加了额外的诊断和预后价值。它可以定量心肌血流，并计算冠状动脉血流储备，与 O-HO 正电子发射断层扫描和有创性血流储备分数具有良好的相关性。此外，患者更喜欢 CCTA/CT-MPI 而非 SPECT、MRI 和有创性冠状动脉造影。CT-MPI 已经准备好用于检测由阻塞性疾病引起的心肌缺血。然而，CT-MPI 确定非阻塞性/微血管疾病患者缺血的临床效用仍有待确定。
CT-MPI 可以提高 CCTA 对特定病变缺血的阳性预测值。
CT-MPI 在主要不良心脏事件方面为 CCTA 增加了额外的预后价值。
CT-MPI 与 O-HO PET 相关。
CT-MPI/CCTA 显示出患者总体满意度高。
