Obara Masahiko, Naya Masanao, Oyama-Manabe Noriko, Aikawa Tadao, Tomiyama Yuuki, Sasaki Tsukasa, Kikuchi Yasuka, Manabe Osamu, Katoh Chietsugu, Tamaki Nagara, Tsutsui Hiroyuki
Department of Cardiovascular Medicine, Hokkaido Chuo Rosai Hospital, Iwamizawa Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine Department of Diagnostic and Interventional Radiology, Hokkaido University Hospital Department of Nuclear Medicine, Hokkaido University Graduate School of Medicine Department of Radiology, Hokkaido University Hospital Center for Cause of Death Investigation, Hokkaido University Graduate School of Medicine Faculty of Health Science, Hokkaido University Graduate School of Medicine, Sapporo, Hokkaido Department of Radiology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto Department of Cardiovascular Medicine, Kyushu University Graduate School of Medical Science, Fukuoka, Japan.
Medicine (Baltimore). 2018 Jul;97(27):e11354. doi: 10.1097/MD.0000000000011354.
We have developed the method for dynamic 320-row multidetector computed tomography (MDCT)-derived quantitative coronary flow reserve (CFRCT) and hyperemic myocardial blood flow (MBFCT). We evaluated diagnostic value of CFRCT and hyperemic MBFCT for detecting obstructive coronary artery disease (CAD) in per-patient and per-vessel analysis, and their relations with the severity of CAD burden.Adenosine stressed and rest dynamic myocardial perfusion MDCT were prospectively performed in patients with known or suspected CAD. Per-patient and per-vessel MBFCT were estimated from dynamic perfusion images in rest and hyperemic phases, and per-patient and per-vessel CFRCT were calculated from the ratio of rest and hyperemic MBFCT. Degree of stenosis was evaluated by coronary CT angiography (CTA) and invasive coronary angiography (ICA). Obstructive stenosis was defined as ≥70% stenosis in ICA. CAD burden with MDCT was calculated by logarithm transformed coronary artery calcium (CAC) score and the CTA-adapted Leaman risk score (CT-LeSc). A logistic regression analysis was used to measure the receiver-operating characteristic curve and corresponding area under the curve (AUC) for the detection of obstructive CAD.Twenty-seven patients and 81 vessels were eligible for this study. Sixteen patients had obstructive CAD, and 31 vessels had obstructive stenosis. Using an optimal cutoff, the CFRCT and hyperemic MBFCT had the moderate diagnostic values in per-patient (AUC = 0.89 and 0.86, respectively) and per-vessel (AUC = 0.79 and 0.76, respectively). Per-patient CFRCT and hyperemic MBFCT exhibited a moderate inverse correlation with CAC score and the CT-LeSc.Per-patient and per-vessel CFRCT as well as hyperemic MBFCT had moderate diagnostic value for detecting obstructive CAD. These per-patient values exhibited a moderate inverse correlation with CAD burden. CFRCT and hyperemic MBFCT might add quantitative functional information for evaluating patients with CAD.
我们已经开发出了用于动态320排多层螺旋计算机断层扫描（MDCT）衍生的定量冠状动脉血流储备（CFRCT）和充血性心肌血流量（MBFCT）的方法。我们在患者个体和血管层面分析中评估了CFRCT和充血性MBFCT对检测阻塞性冠状动脉疾病（CAD）的诊断价值，以及它们与CAD负担严重程度的关系。
对已知或疑似CAD的患者前瞻性地进行了腺苷负荷和静息状态下的动态心肌灌注MDCT检查。从静息期和充血期的动态灌注图像中估计患者个体和血管层面的MBFCT，并根据静息和充血MBFCT的比值计算患者个体和血管层面的CFRCT。通过冠状动脉CT血管造影（CTA）和有创冠状动脉造影（ICA）评估狭窄程度。阻塞性狭窄在ICA中定义为狭窄≥70%。通过对数转换的冠状动脉钙化（CAC）评分和CTA适配的Leaman风险评分（CT-LeSc）计算MDCT的CAD负担。使用逻辑回归分析来测量检测阻塞性CAD的受试者操作特征曲线及相应的曲线下面积（AUC）。
27例患者和81条血管符合本研究条件。16例患者患有阻塞性CAD，31条血管存在阻塞性狭窄。使用最佳截断值时，CFRCT和充血性MBFCT在患者个体层面（AUC分别为0.89和0.86）和血管层面（AUC分别为0.79和0.76）具有中等诊断价值。患者个体的CFRCT和充血性MBFCT与CAC评分和CT-LeSc呈中度负相关。
患者个体和血管层面的CFRCT以及充血性MBFCT对检测阻塞性CAD具有中等诊断价值。这些患者个体值与CAD负担呈中度负相关。CFRCT和充血性MBFCT可能会为评估CAD患者增加定量功能信息。
