Devision of Cardiology, Johns Hopkins Hospital and School of Medicine Baltimore, MD, USA.
Rigshospitalet, University of Copenhagen, Denmark.
J Cardiovasc Comput Tomogr. 2018 May-Jun;12(3):212-219. doi: 10.1016/j.jcct.2018.03.010. Epub 2018 Apr 3.
To determine the diagnostic accuracy of semi-automatic quantitative metrics compared to expert reading for interpretation of computed tomography perfusion (CTP) imaging.
The CORE320 multicenter diagnostic accuracy clinical study enrolled patients between 45 and 85 years of age who were clinically referred for invasive coronary angiography (ICA). Computed tomography angiography (CTA), CTP, single photon emission computed tomography (SPECT), and ICA images were interpreted manually in blinded core laboratories by two experienced readers. Additionally, eight quantitative CTP metrics as continuous values were computed semi-automatically from myocardial and blood attenuation and were combined using logistic regression to derive a final quantitative CTP metric score. For the reference standard, hemodynamically significant coronary artery disease (CAD) was defined as a quantitative ICA stenosis of 50% or greater and a corresponding perfusion defect by SPECT. Diagnostic accuracy was determined by area under the receiver operating characteristic curve (AUC).
Of the total 377 included patients, 66% were male, median age was 62 (IQR: 56, 68) years, and 27% had prior myocardial infarction. In patient based analysis, the AUC (95% CI) for combined CTA-CTP expert reading and combined CTA-CTP semi-automatic quantitative metrics was 0.87(0.84-0.91) and 0.86 (0.83-0.9), respectively. In vessel based analyses the AUC's were 0.85 (0.82-0.88) and 0.84 (0.81-0.87), respectively. No significant difference in AUC was found between combined CTA-CTP expert reading and CTA-CTP semi-automatic quantitative metrics in patient based or vessel based analyses(p > 0.05 for all).
Combined CTA-CTP semi-automatic quantitative metrics is as accurate as CTA-CTP expert reading to detect hemodynamically significant CAD.
确定半自动定量指标与专家解读相比，在解读计算机断层灌注（CTP）成像方面的诊断准确性。
CORE320 多中心诊断准确性临床研究纳入了年龄在 45 至 85 岁之间的患者，这些患者因临床需要接受了有创性冠状动脉造影（ICA）。计算机断层血管造影（CTA）、CTP、单光子发射计算机断层（SPECT）和 ICA 图像由两个有经验的阅片者在盲法核心实验室进行手动解读。此外，还从心肌和血液衰减值半自动计算了八个连续的 CTP 定量指标，并使用逻辑回归对其进行组合，得出最终的 CTP 定量指标评分。对于参考标准，血流动力学意义重大的冠状动脉疾病（CAD）定义为定量 ICA 狭窄 50%或以上，并伴有 SPECT 相应的灌注缺损。诊断准确性通过接受者操作特征曲线下面积（AUC）确定。
在总共 377 名纳入的患者中，66%为男性，中位年龄为 62（IQR：56，68）岁，27%有既往心肌梗死。在患者层面的分析中，联合 CTA-CTP 专家解读和联合 CTA-CTP 半自动定量指标的 AUC（95%CI）分别为 0.87（0.84-0.91）和 0.86（0.83-0.9）。在血管层面的分析中，AUC 分别为 0.85（0.82-0.88）和 0.84（0.81-0.87）。在患者层面和血管层面的分析中，联合 CTA-CTP 专家解读和 CTA-CTP 半自动定量指标的 AUC 之间无显著差异（所有 p 值均>0.05）。
联合 CTA-CTP 半自动定量指标与 CTA-CTP 专家解读在检测血流动力学意义重大的 CAD 方面同样准确。
