Department of Radiology, Ehime University Graduate School of Medicine, Shitsukawa, Toon City, Ehime, Japan.
Department of Radiology, Ehime University Graduate School of Medicine, Shitsukawa, Toon City, Ehime, Japan.
J Cardiol. 2019 May;73(5):425-431. doi: 10.1016/j.jjcc.2018.12.006. Epub 2018 Dec 27.
This study aimed to evaluate the incremental diagnostic value of dynamic myocardial computed tomography (CT) perfusion (CTP) imaging for detecting obstructive coronary artery disease (CAD) in comparison with coronary CT angiography (CTA).
Thirty-eight patients who had undergone coronary CTA and pharmacological stress dynamic CTP before invasive coronary angiography (ICA) were selected retrospectively. Using ICA, obstructive CAD was defined as the presence of severe (≥70%) or moderate (50-69%) stenosis with fractional flow reserve (FFR) <0.75. For CT evaluations, coronary vessels with any stenosis ≥50%, ≥70% or unassessable lesions were considered significantly stenotic. Dynamic CTP was assessed quantitatively using CT-derived myocardial blood flow (CT-MBF). Receiver operating characteristic (ROC) curve analysis determined the cut-off value of CT-MBF for identifying obstructive CAD. The diagnostic performances of CTA alone and integrated CTA and CTP assessments for detecting obstructive CAD were compared.
Using ICA and FFR, 24 of 114 vessels had obstructive CAD. The cut-off value of CT-MBF for detecting obstructive CAD was 1.26mL/g/min. The sensitivity, specificity, and positive and negative predictive values (PPV and NPV) at the vessel level were 96%, 57%, 37%, and 98% for CTA, and 83%, 93%, 77%, and 95% for integrated CTA and CTP assessment using cut-off 50% stenosis on CTA, respectively. The sensitivity, specificity, and PPV and NPV at the vessel level were 79%, 69%, 40%, and 93% for CTA, and 71%, 97%, 85%, and 93% for integrated CTA and CTP assessment using cut-off 70% stenosis on CTA, respectively. The area under the ROC curve for CTA and CTP was significantly higher than that for CTA alone (0.96 vs. 0.84, p<0.05).
Stress dynamic myocardial CTP is feasible to detect hemodynamically obstructive CAD in patients with high pre-test likelihood and helps for improving diagnostic performance in comparison with coronary CTA alone.
本研究旨在评估动态心肌计算机断层扫描（CT）灌注（CTP）成像在检测阻塞性冠状动脉疾病（CAD）方面的增量诊断价值，与冠状动脉 CT 血管造影（CTA）相比。
回顾性选择了 38 名接受过冠状动脉 CTA 和药物应激动态 CTP 检查后行有创冠状动脉造影（ICA）的患者。使用 ICA，严重（≥70%）或中度（50-69%）狭窄伴有血流储备分数（FFR）<0.75 的患者被定义为存在阻塞性 CAD。对于 CT 评估，任何狭窄≥50%、≥70%或无法评估的冠状动脉病变被认为是明显狭窄。使用 CT 衍生的心肌血流（CT-MBF）对动态 CTP 进行定量评估。接受者操作特征（ROC）曲线分析确定了 CT-MBF 用于识别阻塞性 CAD 的截断值。比较了 CTA 单独和 CTA 与 CTP 综合评估对检测阻塞性 CAD 的诊断性能。
使用 ICA 和 FFR，114 个血管中有 24 个存在阻塞性 CAD。用于检测阻塞性 CAD 的 CT-MBF 截断值为 1.26mL/g/min。在血管水平，CTA 的灵敏度、特异性、阳性预测值（PPV）和阴性预测值（NPV）分别为 96%、57%、37%和 98%，而使用 CTA 上 50%狭窄的截断值，CTA 和 CTP 综合评估的灵敏度、特异性、PPV 和 NPV 分别为 83%、93%、77%和 95%。在血管水平，CTA 的灵敏度、特异性、PPV 和 NPV 分别为 79%、69%、40%和 93%，而使用 CTA 上 70%狭窄的截断值，CTA 和 CTP 综合评估的灵敏度、特异性、PPV 和 NPV 分别为 71%、97%、85%和 93%。ROC 曲线下面积（AUC）的 CTA 和 CTP 明显高于 CTA 单独（0.96 比 0.84，p<0.05）。
应激动态心肌 CTP 可用于检测高预测试验可能性患者的血流动力学阻塞性 CAD，并有助于提高与冠状动脉 CTA 单独相比的诊断性能。
