Centro Cardiologico Monzino, IRCCS, Milan, Italy.
Centro Cardiologico Monzino, IRCCS, Milan, Italy.
JACC Cardiovasc Imaging. 2019 Dec;12(12):2460-2471. doi: 10.1016/j.jcmg.2019.02.015. Epub 2019 Apr 17.
The aims of the study were to test the diagnostic accuracy of integrated evaluation of dynamic myocardial computed tomography perfusion (CTP) on top of coronary computed tomography angiography (cCTA) plus fractional flow reserve computed tomography derived (FFR) by using a whole-heart coverage computed tomography (CT) scanner as compared with clinically indicated invasive coronary angiography (ICA) and invasive fractional flow reserve (FFR).
Recently, new techniques such as dynamic stress computed tomography perfusion (stress-CTP) emerged as potential strategies to combine anatomical and functional evaluation in a one-shot scan. However, previous experiences with this technique were associated with high radiation exposure.
Eighty-five consecutive symptomatic patients scheduled for ICA were prospectively enrolled. All patients underwent rest cCTA followed by stress dynamic CTP with a whole-heart coverage CT scanner (Revolution CT, GE Healthcare, Milwaukee, Wisconsin). FFR was also measured by using the rest cCTA dataset. The diagnostic accuracy to detect functionally significant coronary artery disease (CAD) in a vessel-based model of cCTA alone, cCTA+FFR, cCTA+CTP, or cCTA+FFR+CTP were assessed and compared by using ICA and invasive FFR as reference. The overall effective dose of dynamic CTP was also measured.
The prevalence of obstructive CAD and functionally significant CAD was 77% and 57%, respectively. The sensitivity and specificity of cCTA alone, cCTA+FFR, and cCTA+CTP were 83% and 66%, 86% and 75%, and 73% and 86%, respectively. Both the addition of FFR and CTP improves the area under the curve (AUC: 0.876 and 0.878, respectively) as compared with cCTA alone (0.826; p < 0.05). The sequential strategy of cCTA+FFR+CTP showed the highest AUC (0.919; p < 0.05) as compared with all other strategies. The mean effective radiation dose (ED) for cCTA and stress CTP was 2.8 ± 1.2 mSv and 5.3 ± 0.7 mSv, respectively.
The addition of dynamic stress CTP on top of cCTA and FFR provides additional diagnostic accuracy with acceptable radiation exposure.
本研究旨在测试在冠状动脉计算机断层扫描血管造影（cCTA）基础上整合评估动态心肌计算机断层灌注（CTP），并结合基于计算机断层扫描的血流储备分数（FFR），与临床指征性有创冠状动脉造影（ICA）和有创血流储备分数（FFR）相比，使用全心脏覆盖式计算机断层扫描仪（CT）的诊断准确性。
最近，动态应激 CT 灌注（应激-CTP）等新技术作为在单次扫描中结合解剖学和功能评估的潜在策略出现。然而，该技术此前的经验与高辐射暴露有关。
前瞻性纳入 85 例因症状而计划行 ICA 的连续患者。所有患者均接受静息 cCTA 检查，然后使用全心脏覆盖式 CT 扫描仪（Revolution CT，GE Healthcare，密尔沃基，威斯康星州）进行动态应激 CTP 检查。还使用静息 cCTA 数据集测量 FFR。以 ICA 和有创 FFR 为参考，评估并比较 cCTA 单独、cCTA+FFR、cCTA+CTP 或 cCTA+FFR+CTP 的血管基础模型中检测功能性显著冠状动脉疾病（CAD）的诊断准确性。还测量了动态 CTP 的总有效剂量。
阻塞性 CAD 和功能性显著 CAD 的患病率分别为 77%和 57%。cCTA 单独、cCTA+FFR 和 cCTA+CTP 的敏感性和特异性分别为 83%和 66%、86%和 75%、73%和 86%。与 cCTA 单独相比，FFR 和 CTP 的加入均提高了曲线下面积（AUC：0.876 和 0.878）（p<0.05）。cCTA+FFR+CTP 的序贯策略与所有其他策略相比，AUC 最高（0.919；p<0.05）。cCTA 和应激 CTP 的平均有效辐射剂量（ED）分别为 2.8±1.2 mSv 和 5.3±0.7 mSv。
在 cCTA 和 FFR 基础上增加动态应激 CTP 可提供额外的诊断准确性，并具有可接受的辐射暴露。
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