Department of Magnetic Resonance Imaging, Cardiovascular Imaging and Intervention Center, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, China; Department of Health and Human Services, National Heart, Lung and Blood Institute (NHLBI), National Institutes of Health (NIH), Building 10, Room B1D416, MSC 1061, 10 Center Drive, Bethesda, MD, 20892-1061, USA.
Department of Magnetic Resonance Imaging, Cardiovascular Imaging and Intervention Center, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, China.
Int J Cardiol. 2018 May 1;258:325-331. doi: 10.1016/j.ijcard.2018.01.095. Epub 2018 Feb 10.
Comparing to SPECT and MRI, with higher temporal and spatial resolution and development of radiation dose reduction, myocardial computed tomography perfusion has emerged as a potential method for evaluation of hemodynamic myocardial ischemia. This meta-analysis systematically analyzed the performance of dynamic CT myocardial perfusion (DCTMP) to diagnose myocardial ischemia (MI) with clinically established reference methods [MR/SPECT/PET perfusion and fractional flow reserve (FFR)] as the reference standard.
We searched PubMed, Embase and web of science databases for all published studies that evaluated the accuracy of DCTMP to diagnose MI met our inclusion criteria. An exact binomial rendition of the bivariate mixed-effects regression model with test type as a random-effects covariate was performed to synthesize the available data.
The search revealed 13 eligible studies including 482 patients. The pooled sensitivity and specificity of myocardial blood flow (MBF) were 0.83 (95% CI: 0.80 to 0.86) and 0.90 (95% CI: 0.88 to 0.91) at the segment level, 0.85 (95% CI: 0.80 to 0.88) and 0.81 (95% CI: 0.78 to 0.84) at the artery level, and 0.93 (95% CI: 0.82 to 0.98) and 0.82 (95% CI: 0.70 to 0.91), at the patient level, respectively. The high area under the sROC curves of MBF were 0.944 at segment level, 0.911 at vessel level and 0.949 at patient level, respectively.
DCTMP has a high diagnostic accuracy in detecting myocardial ischemia and it may increase significantly at segment level in combined use of coronary CTA.
与单光子发射计算机断层扫描（SPECT）和磁共振成像（MRI）相比，心肌计算机断层灌注检查具有更高的时间和空间分辨率，并且辐射剂量减少，已成为评估血流动力学性心肌缺血的一种潜在方法。本荟萃分析系统地分析了动态 CT 心肌灌注（DCTMP）检测心肌缺血（MI）的性能，将临床上确立的参考方法[MR/SPECT/PET 灌注和血流储备分数（FFR）]作为参考标准。
我们在 PubMed、Embase 和 web of science 数据库中检索了所有评估 DCTMP 诊断 MI 的准确性的已发表研究，这些研究符合我们的纳入标准。使用二项式混合效应回归模型的精确版本，并将测试类型作为随机效应协变量，对可用数据进行综合分析。
搜索结果显示有 13 项符合条件的研究，共纳入 482 例患者。在节段水平，心肌血流量（MBF）的汇总敏感性和特异性分别为 0.83（95%CI：0.80 至 0.86）和 0.90（95%CI：0.88 至 0.91），在动脉水平，分别为 0.85（95%CI：0.80 至 0.88）和 0.81（95%CI：0.78 至 0.84），在患者水平，分别为 0.93（95%CI：0.82 至 0.98）和 0.82（95%CI：0.70 至 0.91）。MBF 的高 sROC 曲线下面积分别为节段水平 0.944、血管水平 0.911 和患者水平 0.949。
DCTMP 在检测心肌缺血方面具有较高的诊断准确性，并且在结合冠状动脉 CT 血管造影检查时，节段水平的准确性可能显著提高。
