University of Chicago Medical Center, Chicago, IL, USA.
University of Chicago Medical Center, Chicago, IL, USA.
J Cardiovasc Comput Tomogr. 2020 Mar-Apr;14(2):185-194. doi: 10.1016/j.jcct.2019.05.011. Epub 2019 Jun 13.
Computed tomography coronary angiography (CTCA) is a widely accepted non-invasive technique for the accurate detection of coronary artery disease (CAD), but comes with a notable limitation stemming from its limited capacity to define the physiologic significance of a given lesion This hampered ability for functional assessment of coronary stenosis may lead to additional testing in an effort to delineate whether ischemia is truly present. An important technique that can overcome this pitfall of CTCA has emerged in the form of stress CT myocardial perfusion (CTP) imaging, which provides the functional assessment necessary, thereby complementing the anatomic information provided by CTCA. The combination of CTCA and CTP permits a single exam to simultaneously detect coronary stenosis and categorize its hemodynamic significance. The accuracy of CTP is now well-described in comparison to a number of reference standards for the diagnosis of CAD, including single photon emission CT, cardiovascular magnetic resonance imaging, and invasive coronary angiography with and without fractional flow-reserve (FFR) measurements. While there is not yet a consensus for a single protocol regarding the optimal mode of acquisition and interpretation of CTP, there is a growing body of data to support its integration into clinical use with CTCA as a strategy to improve the detection and management of coronary disease. This review article is aimed to discuss the current clinical applications and methodology of CTP imaging, its strengths and weaknesses as well as some of the debated issues that remain to be resolved in the future.
计算机断层扫描冠状动脉造影（CTCA）是一种广泛接受的非侵入性技术，用于准确检测冠状动脉疾病（CAD），但存在一个显著的局限性，即其对特定病变的生理意义的定义能力有限。这种对冠状动脉狭窄功能评估的能力有限可能导致需要进行额外的测试，以确定是否存在真正的缺血。一种可以克服 CTCA 这一缺陷的重要技术已经出现，即应激 CT 心肌灌注（CTP）成像，它提供了必要的功能评估，从而补充了 CTCA 提供的解剖信息。CTCA 和 CTP 的结合允许一次检查同时检测冠状动脉狭窄并对其血流动力学意义进行分类。与单光子发射 CT、心血管磁共振成像以及有和无血流储备分数（FFR）测量的有创冠状动脉造影等 CAD 诊断的许多参考标准相比，CTP 的准确性现在已经得到了很好的描述。虽然对于 CTP 的最佳采集和解释模式还没有达成共识，但越来越多的数据支持将其与 CTCA 结合使用，作为一种提高冠状动脉疾病检测和管理的策略。这篇综述文章旨在讨论 CTP 成像的当前临床应用和方法学、其优缺点以及一些仍有待未来解决的有争议的问题。
