Papanastasiou G, Williams M C, Dweck M R, Mirsadraee S, Weir N, Fletcher A, Lucatelli C, Patel D, van Beek E J R, Newby D E, Semple S I K
Edinburgh Imaging facility QMRI (EIf-QMRI) and the Centre for Cardiovascular Science, Edinburgh, EH16 4TJ, UK.
EIf-QMRI and is now with the Royal Brompton and Harefield Hospitals NHS Trust, London, SW3 6NP, UK.
IEEE Trans Radiat Plasma Med Sci. 2018 May;2(3):259-271. doi: 10.1109/TRPMS.2018.2796626. Epub 2018 Jan 23.
Kinetic modelling of myocardial perfusion imaging data allows the absolute quantification of myocardial blood flow (MBF) and can improve the diagnosis and clinical assessment of coronary artery disease (CAD). Positron emission tomography (PET) imaging is considered the reference standard technique for absolute quantification, whilst oxygen-15 (O)-water has been extensively implemented for MBF quantification. Dynamic contrast enhanced magnetic resonance imaging (DCE-MRI) has also been used for MBF quantification and showed comparable diagnostic performance against (O)-water PET studies. We investigated for the first time the diagnostic performance of two different PET MBF analysis softwares PMOD and Carimas, for obstructive CAD detection against invasive clinical standard methods in 20 patients with known or suspected CAD. Fermi and distributed parameter modelling-derived MBF quantification from DCE-MRI was also compared against (O)-water PET, in a subgroup of 6 patients. The sensitivity and specificity for PMOD was significantly superior for obstructive CAD detection in both per vessel (0.83, 0.90) and per patient (0.86, 0.75) analysis, against Carimas (0.75, 0.65), (0.81, 0.70), respectively. We showed strong, significant correlations between MR and PET MBF quantifications (r=0.83-0.92). However, DP and PMOD analysis demonstrated comparable and higher haemodynamic differences between obstructive versus (no, minor or non)-obstructive CAD, against Fermi and Carimas analysis. Our MR method assessments against the optimum PET reference standard technique for perfusion analysis showed promising results in per segment level and can support further multi-modality assessments in larger patient cohorts. Further MR against PET assessments may help to determine their comparative diagnostic performance for obstructive CAD detection.
心肌灌注成像数据的动力学建模可实现心肌血流量（MBF）的绝对定量，并能改善冠状动脉疾病（CAD）的诊断和临床评估。正电子发射断层扫描（PET）成像被认为是绝对定量的参考标准技术，而氧-15（O）-水已被广泛用于MBF定量。动态对比增强磁共振成像（DCE-MRI）也被用于MBF定量，并且在与（O）-水PET研究的对比中显示出相当的诊断性能。我们首次研究了两种不同的PET MBF分析软件PMOD和Carimas针对20例已知或疑似CAD患者的阻塞性CAD检测相对于侵入性临床标准方法的诊断性能。在6例患者的亚组中，还将DCE-MRI衍生的费米和分布参数建模的MBF定量与（O）-水PET进行了比较。在按血管（0.83，0.90）和按患者（0.86，0.75）分析中，PMOD检测阻塞性CAD的敏感性和特异性分别显著优于Carimas（0.75，0.65），（0.81，0.70）。我们发现MR和PET MBF定量之间存在强且显著的相关性（r = 0.83 - 0.92）。然而，与费米和Carimas分析相比，DP和PMOD分析在阻塞性与（无、轻度或非）阻塞性CAD之间显示出相当且更高的血流动力学差异。我们针对灌注分析的最佳PET参考标准技术进行的MR方法评估在每个节段水平上显示出有前景的结果，并可支持在更大患者队列中的进一步多模态评估。进一步的MR与PET评估可能有助于确定它们在检测阻塞性CAD方面的比较诊断性能。
