1.5T 和 3T 应激心肌灌注心血管磁共振检测显著冠状动脉疾病的诊断准确性比较。

Comparison of the Diagnostic Accuracies of 1.5T and 3T Stress Myocardial Perfusion Cardiovascular Magnetic Resonance for Detecting Significant Coronary Artery Disease.

机构信息

Department of Radiology, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul 05030, Korea.

Department of Cardiology, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul 05030, Korea.

出版信息

Korean J Radiol. 2018 Nov-Dec;19(6):1007-1020. doi: 10.3348/kjr.2018.19.6.1007. Epub 2018 Oct 18.

OBJECTIVE

To compare the diagnostic performance of cardiovascular magnetic resonance (CMR) myocardial perfusion at 1.5- and 3-tesla (T) for detecting significant coronary artery disease (CAD), with invasive coronary angiography (ICA) as the reference method.

MATERIALS AND METHODS

We prospectively enrolled 281 patients (age 62.4 ± 8.3 years, 193 men) with suspected or known CAD who had undergone 1.5T or 3T CMR and ICA. Two independent radiologists interpreted perfusion defects. With ICA as the reference standard, the diagnostic performance of 1.5T and 3T CMR for identifying significant CAD (≥ 50% diameter reduction of the left main and ≥ 70% diameter reduction of other epicardial arteries) was determined.

RESULTS

No differences were observed in baseline characteristics or prevalence of CAD and old myocardial infarction (MI) using 1.5T (n = 135) or 3T (n = 146) systems. Sensitivity, specificity, positive and negative predictive values, and area under the receiver operating characteristic curve (AUC) for detecting significant CAD were similar between the 1.5T (84%, 64%, 74%, 76%, and 0.75 per patient and 68%, 83%, 66%, 84%, and 0.76 per vessel) and 3T (80%, 71%, 71%, 80%, and 0.76 per patient and 75%, 86%, 64%, 91%, and 0.81 per vessel) systems. In patients with multi-vessel CAD without old MI, the sensitivity, specificity, and AUC with 3T were greater than those with 1.5T on a per-vessel basis (71% vs. 36%, 92% vs. 69%, and 0.82 vs. 0.53, respectively).

CONCLUSION

3T CMR has similar diagnostic performance to 1.5T CMR in detecting significant CAD, except for higher diagnostic performance in patients with multi-vessel CAD without old MI.

目的

比较 1.5T 和 3T 磁共振心肌灌注成像（CMR）诊断冠状动脉疾病（CAD）的效能，以冠状动脉造影（ICA）为参考方法。

材料与方法

前瞻性纳入 281 例可疑或已知 CAD 患者（年龄 62.4±8.3 岁，男性 193 例），行 1.5T 或 3T CMR 及 ICA 检查。由 2 位独立的放射科医师评估灌注缺损。以 ICA 为参考标准，评估 1.5T 和 3T CMR 诊断 1.5T 和 3T CMR 诊断明确 CAD（≥50%的左主干直径狭窄和≥70%的其他心外膜动脉直径狭窄）的效能。

结果

1.5T（n=135）和 3T（n=146）系统的基线特征和 CAD 及陈旧性心肌梗死（MI）患病率无差异。1.5T 和 3T 系统检测明确 CAD 的敏感度、特异度、阳性预测值、阴性预测值和受试者工作特征曲线下面积（AUC）分别为 84%、64%、74%、76%和 0.75/患者和 68%、83%、66%、84%和 0.76/血管；80%、71%、71%、80%和 0.76/患者和 75%、86%、64%、91%和 0.81/血管。无陈旧性 MI 的多支 CAD 患者中，3T 系统的敏感度、特异度和 AUC 优于 1.5T（71% vs. 36%、92% vs. 69%、0.82 vs. 0.53）。