Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No.1, Shuaifuyuan, Dongcheng District, Beijing, 100730, China.
Department of Cardiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China.
Eur Radiol. 2021 Feb;31(2):1119-1129. doi: 10.1007/s00330-020-07096-x. Epub 2020 Aug 18.
To investigate the diagnostic performance of 70-kVp stress dynamic myocardial CT perfusion (CTP) as a low-dose, one-stop cardiac CT examination in clinical application.
Consecutive symptomatic patients were prospectively recruited and scanned with stress dynamic myocardial CTP. The CTP phase with the best enhancement of the coronary arteries was selected and extracted as the CTP-derived single-phase coronary CT angiography (SP-CTA). The diagnostic performance of CTP and CTP+SP-CTA for functionally significant CAD was assessed. Invasive coronary angiography and fractional flow reserve were used as the reference standard for the myocardial ischemia evaluation.
In total, 71 patients (43 men and 28 women; 63.6 ± 8.8 years old) underwent the stress dynamic myocardial CTP; 63 vessels (36.2%) from 42 of the patients (59.2%) were identified as causing ischemia. On a per-vessel basis, the sensitivity, specificity, PPV, NPV, and diagnostic accuracy for CTP and CTP+SP-CTA were 77.8%, 93.7%, 87.5%, 88.1%, and 87.9% and 84.1%, 93.7%, 88.3%, 91.2%, and 90.2%, respectively. The area under the curve (AUC) of CTP+SP-CTA (AUC = 0.963; 95%CI, 0.938-0.989) was significantly superior to that of CTP (AUC = 0.922; 95%CI, 0.880-0.964) and that of SP-CTA (AUC = 0.833; 95%CI, 0.765-0.900) alone (all p < 0.01). The mean radiation dose of the CTP examination was 3.8 ± 1.4 mSv.
CTP-derived SP-CTA improved the diagnostic value of CTP. With a promising performance of myocardial ischemia detection and low radiation dose, the innovative low-dose, one-stop CTP examination is clinically feasible for patients who need to receive a myocardial perfusion assessment.
• Myocardial CTP performed well in the evaluation of hemodynamically significant CAD. • CTP-derived single-phase CCTA improved the diagnostic value of CTP. • The combined use of low-dose CTP and CTP-derived CCTA at 70 kVp is clinically feasible for CAD patients who need to receive a myocardial perfusion assessment.
探讨 70kVp 负荷动态心肌 CT 灌注（CTP）作为一种低剂量一站式心脏 CT 检查在临床应用中的诊断性能。
连续纳入有症状的患者进行负荷动态心肌 CTP 扫描。选择冠状动脉强化最佳的 CTP 期相并提取为 CTP 衍生的单相冠状动脉 CT 血管造影（SP-CTA）。评估 CTP 和 CTP+SP-CTA 对功能性显著 CAD 的诊断性能。以有创冠状动脉造影和血流储备分数作为心肌缺血评估的参考标准。
共 71 例患者（43 名男性和 28 名女性；63.6±8.8 岁）进行了负荷动态心肌 CTP 检查；42 例患者中的 63 支血管（36.2%）被确定为导致缺血。基于单支血管，CTP 和 CTP+SP-CTA 的敏感性、特异性、PPV、NPV 和诊断准确性分别为 77.8%、93.7%、87.5%、88.1%和 87.9%和 84.1%、93.7%、88.3%、91.2%和 90.2%。CTP+SP-CTA 的曲线下面积（AUC）（AUC=0.963；95%CI，0.938-0.989）明显优于 CTP（AUC=0.922；95%CI，0.880-0.964）和单独的 SP-CTA（AUC=0.833；95%CI，0.765-0.900）（均 p<0.01）。CTP 检查的平均辐射剂量为 3.8±1.4mSv。
CTP 衍生的 SP-CTA 提高了 CTP 的诊断价值。低剂量一站式 CTP 检查具有良好的心肌缺血检测性能和低辐射剂量，可为需要进行心肌灌注评估的患者提供临床可行性。
心肌 CTP 对评估有血流动力学意义的 CAD 表现良好。
CTP 衍生的单相 CCTA 提高了 CTP 的诊断价值。
在 70kVp 下，低剂量 CTP 和 CTP 衍生的 CCTA 的联合使用对需要进行心肌灌注评估的 CAD 患者具有临床可行性。
