Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China.
Department of Cardiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China.
J Cardiovasc Comput Tomogr. 2020 Sep-Oct;14(5):437-443. doi: 10.1016/j.jcct.2020.01.010. Epub 2020 Jan 30.
The optimization of myocardial CT perfusion (CTP) assessment remains inconsistent and uncertain. Our aim was to explore the superior analysis selection and incremental improvement of myocardial blood flow (MBF) assessment on CTP in diagnosing hemodynamically significant coronary artery disease (CAD).
Sixty patients (43 men and 17 women; 61.38 ± 8.01 years) were prospectively recruited and underwent stress dynamic myocardial CTP examinations. Absolute and relative MBF was used for ischemia evaluation with the invasive coronary angiography and fractional flow reserve were used as the reference standard. Areas under the receiver operating characteristic curves (AUCs) and cutoff values were calculated and compared.
There were 151 vessels in 60 patients finally enrolled for analysis. The sensitivity, specificity, PPV, NPV and diagnostic accuracy for the absolute MBF value and relative MBF ratio were 82.76%, 98.92%, 97.96%, 90.20%, and 92.72% and 74.14%, 93.56%, 87.76%, 85.29%, and 86.09%, respectively. The absolute MBF value was superior than the relative MBF ratio in detecting ischemia (AUC, 0.955 [95%CI: 0.919-0.990] vs.0.906 [95%CI:0.857-0.954])(P = 0.02). For territories with both sensitivity and specificity ≤90%, the diagnostic accuracy increased from 79.1% to 88.4% when the specific data were assessed using the absolute MBF value instead of the relative MBF ratio.
The absolute MBF value from the endocardial myocardium on stress dynamic myocardial CTP showed superior diagnostic performance compared to the relative MBF ratio for the detection of myocardial ischemia in intermediate-to-high risk patients. The absolute MBF value provides an incremental benefit toward diagnostic performance for the relative MBF ratio evaluation.
心肌 CT 灌注（CTP）评估的优化仍然不一致且不确定。我们的目的是探索在诊断有意义的冠状动脉疾病（CAD）方面，CTP 评估心肌血流（MBF）的分析选择和增量改善的优势。
前瞻性招募了 60 名患者（43 名男性和 17 名女性；61.38±8.01 岁），并进行了应激动态心肌 CTP 检查。使用有创冠状动脉造影评估绝对和相对 MBF 用于缺血评估，并使用血流储备分数作为参考标准。计算并比较了受试者工作特征曲线（AUC）下的面积和截断值。
最终纳入 60 名患者的 151 支血管进行分析。绝对 MBF 值和相对 MBF 比值的灵敏度、特异性、PPV、NPV 和诊断准确性分别为 82.76%、98.92%、97.96%、90.20%和 92.72%和 74.14%、93.56%、87.76%、85.29%和 86.09%。绝对 MBF 值在检测缺血方面优于相对 MBF 比值（AUC，0.955 [95%CI：0.919-0.990] vs.0.906 [95%CI：0.857-0.954]）（P=0.02）。对于敏感性和特异性均≤90%的区域，当使用绝对 MBF 值评估特定数据而不是相对 MBF 比值时，诊断准确性从 79.1%增加到 88.4%。
在中高危患者中，应激动态心肌 CTP 下心内膜心肌的绝对 MBF 值在检测心肌缺血方面的诊断性能优于相对 MBF 比值。绝对 MBF 值对相对 MBF 比值评估的诊断性能具有增量效益。
