Huang I-Lun, Wu Ming-Ting, Hu Chin, Mar Guang-Yuan, Lee Ting-Yim, So Aaron
Radiology, Kaohsiung Veteran General Hospital, Kaohsiung, Taiwan.
Faculty of Medicine, School of Medicine, National Yang Ming University, Taipei, Taiwan.
Int J Cardiol Heart Vasc. 2019 Jun 20;24:100381. doi: 10.1016/j.ijcha.2019.100381. eCollection 2019 Sep.
We evaluated the diagnostic accuracy of myocardial blood flow (MBF) and perfusion reserve (MPR) measured from low-dose dynamic contrast-enhanced (DCE) imaging with a whole-heart coverage CT scanner for detecting functionally significant coronary artery disease (CAD).
Twenty one patients with suspected or known CAD had rest and dipyridamole stress MBF measurements with CT and SPECT myocardial perfusion imaging (MPI), and lumen narrowing assessment with coronary angiography (catheter and/or CT based) within 6 weeks. SPECT MBF measurements and coronary angiography were used together as reference to determine the functional significance of coronary artery stenosis. In each CT MPI study, DCE images of the whole heart were acquired with breath-hold using a low-dose acquisition protocol to generate MBF maps. Binomial logistic regression analysis was used to determine the diagnostic accuracy of CT-measured MBF and MPR (ratio of stress to rest MBF) for assessing functionally significant coronary stenosis.
Mean stress MBF and MPR in ischemic segments were lower than those in non-ischemic segments (1.37 ± 0.34 vs. 2.14 ± 0.64 ml/min/g; 1.56 ± 0.41 vs. 2.53 ± 0.70; p < 0.05 for all). The receiver operating characteristic curve analysis revealed that MPR (AUC 0.916, 95%CI: 0.885-0.947) had a superior power than stress MBF (AUC 0.869, 95%CI: 0.830-0.909) for differentiating non-ischemic and ischemic myocardial segments (p = 0.045). On a per-vessel and per-segment analysis, concomitant use of MPR and stress MBF thresholds further improved the diagnostic accuracy compared to MPR or stress MBF alone for detecting obstructive coronary lesions (per-vessel: 93.4% vs. 83.6% and 88.5%, respectively; per-segment: 90.0% vs. 83.7% and 83.1%, respectively). The estimated effective dose of a rest and stress CT MPI study was 3.04 and 3.19 mSv respectively.
Quantitative rest and stress myocardial perfusion measurement with a large-coverage CT scanner improves the diagnostic accuracy for detecting functionally significant coronary stenosis.
我们评估了使用全心脏覆盖CT扫描仪通过低剂量动态对比增强（DCE）成像测量的心肌血流（MBF）和灌注储备（MPR）对检测功能上有意义的冠状动脉疾病（CAD）的诊断准确性。
21例疑似或已知CAD的患者在6周内接受了CT和单光子发射计算机断层扫描心肌灌注成像（MPI）的静息和双嘧达莫负荷MBF测量，以及基于导管和/或CT的冠状动脉造影进行管腔狭窄评估。将SPECT MBF测量和冠状动脉造影一起用作参考，以确定冠状动脉狭窄的功能意义。在每项CT MPI研究中，使用低剂量采集方案屏气采集全心脏的DCE图像以生成MBF图。采用二项逻辑回归分析来确定CT测量的MBF和MPR（负荷与静息MBF之比）对评估功能上有意义的冠状动脉狭窄的诊断准确性。
缺血节段的平均负荷MBF和MPR低于非缺血节段（分别为1.37±0.34 vs. 2.14±0.64 ml/min/g；1.56±0.41 vs. 2.53±0.70；所有p<0.05）。受试者工作特征曲线分析显示，在区分非缺血和缺血心肌节段方面，MPR（曲线下面积[AUC]0.916，95%可信区间[CI]：0.885 - 0.947）比负荷MBF（AUC 0.869，95%CI：0.830 - 0.909）具有更高的效能（p = 0.045）。在每支血管和每节段分析中，与单独使用MPR或负荷MBF相比，联合使用MPR和负荷MBF阈值进一步提高了检测阻塞性冠状动脉病变的诊断准确性（每支血管：分别为93.4% vs. 83.6%和88.5%；每节段：分别为90.0% vs. 83.7%和83.1%）。静息和负荷CT MPI研究的估计有效剂量分别为3.04和3.19 mSv。
使用大覆盖范围CT扫描仪进行定量静息和负荷心肌灌注测量可提高检测功能上有意义的冠状动脉狭窄的诊断准确性。
