左主干或等效冠状动脉疾病中心血管磁共振与单光子发射计算机断层扫描（SPECT）灌注成像的比较：CE-MARC 子研究。
A comparison of cardiovascular magnetic resonance and single photon emission computed tomography (SPECT) perfusion imaging in left main stem or equivalent coronary artery disease: a CE-MARC substudy.
机构信息
Multidisciplinary Cardiovascular Research Centre & The Division of Biomedical Imaging, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, LS2 9JT, UK.
Cardiology Department, Leeds General Infirmary, Leeds, UK.
出版信息
J Cardiovasc Magn Reson. 2017 Nov 6;19(1):84. doi: 10.1186/s12968-017-0398-7.
BACKGROUND
Assessment of left main stem (LMS) stenosis has prognostic and therapeutic implications. Data on assessment of LMS disease by cardiovascular magnetic resonance (CMR) and single photon emission computed tomography (SPECT) are limited. CE-MARC is the largest prospective comparison of CMR and SPECT against quantitative invasive coronary angiography (QCA) for detection of coronary artery disease (CAD), and provided the framework for this evaluation. The aims of this study were to compare diagnostic accuracy of visual and quantitative perfusion CMR to SPECT in patients with LMS stable CAD.
METHODS
Fifty-four patients from the CE-MARC study were included: 27 (4%) with significant LMS or LMS-equivalent disease on QCA, and 27 age/sex-matched patients with no flow-limiting CAD. All patients underwent multi-parametric CMR, SPECT and QCA. Performance of visual and quantitative perfusion CMR by Fermi-constrained deconvolution to detect LMS disease was compared with SPECT.
RESULTS
Of 27 patients in the LMS group, 22 (81%) had abnormal CMR and 16 (59%) had abnormal SPECT. All patients with abnormal CMR had abnormal perfusion by visual analysis. CMR demonstrated significantly higher area under the curve (AUC) for detection of disease (0.95; 0.85-0.99) over SPECT (0.63; 0.49-0.76) (p = 0.0001). Global mean stress myocardial blood flow (MBF) by CMR in LMS patients was significantly lower than controls (1.77 ± 0.72 ml/g/min vs. 3.28 ± 1.20 ml/g/min, p < 0.001). MBF of <2.08 ml/g/min had sensitivity of 78% and specificity of 85% for diagnosis of LMS disease, with an AUC (0.87; 0.75-0.94) not significantly different to visual CMR analysis (p = 0.18), and more accurate than SPECT (p = 0.003).
CONCLUSION
Visual stress perfusion CMR had higher diagnostic accuracy than SPECT to detect LMS disease. Quantitative perfusion CMR had similar performance to visual CMR perfusion analysis.
背景
左主干（LMS）狭窄的评估具有预后和治疗意义。心血管磁共振（CMR）和单光子发射计算机断层扫描（SPECT）评估 LMS 疾病的数据有限。CE-MARC 是迄今为止最大的前瞻性比较 CMR 和 SPECT 与定量冠状动脉造影（QCA）在检测冠状动脉疾病（CAD）方面的比较，为这项评估提供了框架。本研究的目的是比较视觉和定量灌注 CMR 与 SPECT 在 LMS 稳定性 CAD 患者中的诊断准确性。
方法
CE-MARC 研究中的 54 例患者被纳入：27 例（4%）患者 QCA 显示有显著的 LMS 或 LMS 等效病变，27 例年龄/性别匹配的患者无血流受限 CAD。所有患者均行多参数 CMR、SPECT 和 QCA 检查。采用费米约束反卷积对视觉和定量灌注 CMR 进行分析，以检测 LMS 疾病，并与 SPECT 进行比较。
结果
在 LMS 组的 27 例患者中，22 例（81%）患者 CMR 异常，16 例（59%）患者 SPECT 异常。所有 CMR 异常患者的灌注均通过视觉分析显示异常。CMR 检测疾病的曲线下面积（AUC）显著高于 SPECT（0.95；0.85-0.99 比 0.63；0.49-0.76）（p=0.0001）。LMS 患者的全局平均应激心肌血流（MBF）通过 CMR 测量明显低于对照组（1.77±0.72 ml/g/min 比 3.28±1.20 ml/g/min，p<0.001）。MBF<2.08 ml/g/min 对 LMS 疾病的诊断具有 78%的敏感性和 85%的特异性，其 AUC（0.87；0.75-0.94）与视觉 CMR 分析无显著差异（p=0.18），且比 SPECT 更准确（p=0.003）。
结论
视觉应激灌注 CMR 检测 LMS 疾病的诊断准确性高于 SPECT。定量灌注 CMR 与视觉 CMR 灌注分析具有相似的性能。
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