Department of Radiology, New Tokyo Hospital, Chiba, Japan; Department of Radiology, Juntendo University School of Medicine, Tokyo, Japan.
Department of Diabetes, New Tokyo Hospital, Chiba, Japan.
J Cardiovasc Comput Tomogr. 2019 Jan-Feb;13(1):55-61. doi: 10.1016/j.jcct.2018.10.003. Epub 2018 Oct 6.
Dynamic myocardial computed tomography perfusion (CTP) is an emerging technique to diagnose significant coronary stenosis. However, this procedure has not been reported using single-source 64-row CT.
To investigate the radiation dose and the diagnostic performance of dynamic CTP to diagnose significant stenosis by catheter exam.
We prospectively included 165 patients who underwent CTP exam under adenosine stress using a single-source 64-row CT. MBF was calculated using the deconvolution technique. Quantitative perfusion ratio (QPR) was defined as the myocardial blood flow (MBF) of the myocardium with coronary stenosis divided by the MBF of the myocardium without significant stenosis or infarct. Of the 44 patients who underwent subsequent coronary angiography, we assessed the diagnostic performance to diagnose ≥50% stenosis by quantitative coronary analysis (QCA).
The average effective dose of dynamic CTP and the entire scans were 2.5 ± 0.7 and 7.3 ± 1.8 mSv, respectively. The MBF of the myocardium without significant stenosis was 1.20 ± 0.32 ml/min/g, which significantly decreased to 0.98 ± 0.24 ml/min/g (p < 0.01) in the area with ≥50% stenosis by CT angiography. The QPR of the myocardium with QCA ≥50% stenosis was significantly lower than 1 (0.84 ± 0.32, 95% confidence interval (CI), 0.77-0.90, p < 0.001). The accuracy to detect QCA ≥50% stenosis was 82% (95%CI, 74-88%) using CT angiography alone and significantly increased to 87% (95%CI, 80-92%, p < 0.05) including QPR.
Dynamic myocardial CTP could be performed using 64-row CT with a low radiation dose and would improve the diagnostic performance to detect QCA ≥50% stenosis than CT angiography alone.
动态心肌计算机断层灌注（CTP）是一种新兴的诊断显著冠状动脉狭窄的技术。然而，这项技术尚未使用单源 64 排 CT 进行报道。
使用单源 64 排 CT 研究动态 CTP 的辐射剂量和诊断性能，以诊断导管检查中的显著狭窄。
我们前瞻性地纳入了 165 例接受腺苷负荷下 CTP 检查的患者。使用去卷积技术计算 MBF。定量灌注比（QPR）定义为存在冠状动脉狭窄的心肌血流（MBF）与无显著狭窄或梗死的心肌的 MBF 之比。在 44 例行后续冠状动脉造影的患者中，我们评估了通过定量冠状动脉分析（QCA）诊断≥50%狭窄的诊断性能。
动态 CTP 和整个扫描的平均有效剂量分别为 2.5±0.7 和 7.3±1.8 mSv。无显著狭窄的心肌 MBF 为 1.20±0.32 ml/min/g，在 CT 血管造影显示≥50%狭窄的区域显著降低至 0.98±0.24 ml/min/g（p<0.01）。QCA 狭窄≥50%的心肌 QPR 显著低于 1（0.84±0.32，95%置信区间（CI）0.77-0.90，p<0.001）。单独使用 CT 血管造影检测 QCA 狭窄≥50%的准确率为 82%（95%CI，74-88%），包括 QPR 后显著提高至 87%（95%CI，80-92%，p<0.05）。
使用低剂量辐射的 64 排 CT 可进行动态心肌 CTP，与单独使用 CT 血管造影相比，可提高诊断检测 QCA 狭窄≥50%的性能。
