冠状动脉疾病中的定量心肌灌注：一项灌注绘图研究。
Quantitative myocardial perfusion in coronary artery disease: A perfusion mapping study.
机构信息
University College London, Institute of Cardiovascular Science, London, UK.
Barts Heart Centre, St Bartholomew's Hospital, London, UK.
出版信息
J Magn Reson Imaging. 2019 Sep;50(3):756-762. doi: 10.1002/jmri.26668. Epub 2019 Jan 25.
BACKGROUND
Cardiac MR stress perfusion remains a qualitative technique in clinical practice due to technical and postprocessing challenges. However, automated inline perfusion mapping now permits myocardial blood flow (MBF, ml/g/min) quantification on-the-fly without user input.
PURPOSE
To investigate the diagnostic performance of this novel technique in detecting occlusive coronary artery disease (CAD) in patients scheduled to undergo coronary angiography.
STUDY TYPE
Prospective, observational.
SUBJECTS
Fifty patients with suspected CAD and 24 healthy volunteers.
FIELD STRENGTH
1.5T. SEQUENCE: "Dual" sequence multislice 2D saturation recovery.
ASSESSMENT
All patients underwent cardiac MR with perfusion mapping and invasive coronary angiography; the healthy volunteers had MR with perfusion mapping alone.
STATISTICAL TESTS
Comparison between numerical variables was performed using an independent t-test. Receiver operator characteristic (ROC) curves were generated for transmyocardial, endocardial stress MBF, and myocardial perfusion reserve (MPR, the stress:rest MBF ratio) to diagnose severe (>70%) stenoses as measured by 3D quantitative coronary angiography (QCA). ROC curves were compared by the method of DeLong et al. RESULTS: Compared with volunteers, patients had lower stress MBF and MPR even in vessels with <50% stenosis (2.00 vs. 3.08 ml/g/min, respectively). As stenosis severity increased (<50%, 50-70%, >70%), MBF and MPR decreased. To diagnose occlusive (>70%) CAD, endocardial and transmyocardial stress MBF were superior to MPR (area under the curve 0.92 [95% CI 0.86-0.97] vs. 0.90 [95% CI 0.84-0.95] and 0.80 [95% CI 0.72-0.87], respectively). An endocardial threshold of 1.31 ml/g/min provided a per-coronary artery sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of 90%, 82%, 50%, and 98%, with a per-patient diagnostic performance of 100%, 66%, 57%, and 100%, respectively.
DATA CONCLUSION
Perfusion mapping can diagnose occlusive CAD with high accuracy and, in particular, high sensitivity and NPV make it a potential "rule-out" test.
LEVEL OF EVIDENCE
1 Technical Efficacy Stage: 2 J. Magn. Reson. Imaging 2019;50:756-762.
背景
由于技术和后处理方面的挑战，心脏磁共振（MR）压力灌注在临床实践中仍然是一种定性技术。然而，现在的自动化在线灌注映射技术可以在无需用户输入的情况下实时定量测量心肌血流量（MBF，ml/g/min）。
目的
研究这项新技术在检测计划接受冠状动脉造影的疑似冠心病（CAD）患者中的诊断性能。
研究类型
前瞻性、观察性研究。
对象
50 名疑似 CAD 患者和 24 名健康志愿者。
磁场强度
1.5T。序列：双序列多层 2D 饱和恢复。
评估
所有患者均接受了灌注映射的心脏 MR 检查和有创冠状动脉造影检查；健康志愿者仅接受了灌注映射的心脏 MR 检查。
统计学检验
采用独立 t 检验比较数值变量。为了诊断由 3D 定量冠状动脉造影（QCA）测量的严重（>70%）狭窄，为跨壁、心内膜压力 MBF 和心肌灌注储备（MPR，压力：休息 MBF 比值）生成了受试者工作特征（ROC）曲线。DeLong 等人的方法比较了 ROC 曲线。
结果
与志愿者相比，即使在狭窄程度<50%的血管中，患者的压力 MBF 和 MPR 也较低（分别为 2.00 和 3.08 ml/g/min）。随着狭窄程度的增加（<50%、50-70%、>70%），MBF 和 MPR 降低。为了诊断阻塞性（>70%）CAD，心内膜和跨壁压力 MBF 优于 MPR（曲线下面积分别为 0.92[95%CI 0.86-0.97]和 0.80[95%CI 0.72-0.87]）。心内膜阈值为 1.31 ml/g/min 时，每支冠状动脉的敏感性、特异性、阳性预测值（PPV）和阴性预测值（NPV）分别为 90%、82%、50%和 98%，每例患者的诊断性能分别为 100%、66%、57%和 100%。
数据结论
灌注映射可以准确诊断阻塞性 CAD，特别是高灵敏度和高 NPV 使其成为一种潜在的“排除”试验。
证据水平
1 技术功效阶段：2 J. Magn. Reson. Imaging 2019;50:756-762.
Zotero 插件