定性磁共振和定量动态计算机断层扫描的应激心肌灌注：与冠状动脉计算机断层扫描血管造影相比的诊断性能和增加值
Stress myocardial perfusion with qualitative magnetic resonance and quantitative dynamic computed tomography: comparison of diagnostic performance and incremental value over coronary computed tomography angiography.
作者信息
de Knegt Martina C, Rossi Alexia, Petersen Steffen E, Wragg Andrew, Khurram Ruhaid, Westwood Mark, Saberwal Bunny, Mathur Anthony, Nieman Koen, Bamberg Fabian, Jensen Magnus T, Pugliese Francesca
机构信息
Centre for Advanced Cardiovascular Imaging, William Harvey Research Institute, Barts NIHR Biomedical Research Centre, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, UK.
Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, West Smithfield, London EC1A 7BE, UK.
出版信息
Eur Heart J Cardiovasc Imaging. 2020 Oct 8. doi: 10.1093/ehjci/jeaa270.
AIMS
Assessment of haemodynamically significant coronary artery disease (CAD) using cardiovascular magnetic resonance (CMR) imaging perfusion or dynamic stress myocardial perfusion imaging by computed tomography (CT perfusion) may aid patient selection for invasive coronary angiography (ICA). We evaluated the diagnostic performance and incremental value of qualitative CMR perfusion and quantitative CT perfusion complementary to cardiac computed tomography angiography (CCTA) for the diagnosis of haemodynamically significant CAD using fractional flow reserve (FFR) and quantitative coronary angiography (QCA) as reference standard.
METHODS AND RESULTS
CCTA, qualitative visual CMR perfusion, visual CT perfusion, and quantitative relative myocardial blood flow (CT-MBF) were performed in patients with stable angina pectoris. FFR was measured in coronary vessels with stenosis visually estimated between 30% and 90% diameter reduction on ICA. Haemodynamically significant CAD was defined as FFR <0.80, or QCA ≥80% in those cases where FFR could not be performed. A total of 218 vessels from 93 patients were assessed. An optimal cut-off of 0.72 for relative CT-MBF was determined. The diagnostic performances (area under the receiver-operating characteristics curves, 95% CI) of visual CMR perfusion (0.84, 0.77-0.90) and relative CT-MBF (0.86, 0.81-0.92) were comparable and outperformed visual CT perfusion (0.64, 0.57-0.71). In combination with CCTA ≥50%, CCTA + visual CMR perfusion (0.91, 0.86-0.96), CCTA + relative CT-MBF (0.92, 0.88-0.96), and CCTA + visual CT perfusion (0.82, 0.75-0.90) improved discrimination compared with CCTA alone (all P < 0.05).
CONCLUSION
Visual CMR perfusion and relative CT-MBF outperformed visual CT perfusion and provided incremental discrimination compared with CCTA alone for the diagnosis of haemodynamically significant CAD.
目的
使用心血管磁共振（CMR）成像灌注或计算机断层扫描动态应力心肌灌注成像（CT灌注）评估血流动力学显著冠状动脉疾病（CAD），可能有助于选择进行有创冠状动脉造影（ICA）的患者。我们使用血流储备分数（FFR）和定量冠状动脉造影（QCA）作为参考标准，评估了定性CMR灌注和定量CT灌注对心脏计算机断层扫描血管造影（CCTA）诊断血流动力学显著CAD的诊断性能和增量价值。
方法和结果
对稳定型心绞痛患者进行CCTA、定性视觉CMR灌注、视觉CT灌注和定量相对心肌血流量（CT-MBF）检查。在ICA上目测估计直径狭窄30%至90%的冠状动脉血管中测量FFR。血流动力学显著CAD定义为FFR<0.80，或在无法进行FFR的情况下QCA≥80%。共评估了93例患者的218条血管。确定相对CT-MBF的最佳截断值为0.72。视觉CMR灌注（0.84，0.77 - 0.90）和相对CT-MBF（0.86，0.81 - 0.92）的诊断性能（受试者操作特征曲线下面积，95%CI）相当，且优于视觉CT灌注（0.64，0.57 - 0.71）。与单独的CCTA相比，当CCTA≥50%时，CCTA + 视觉CMR灌注（0.91，0.86 - 0.96）、CCTA + 相对CT-MBF（0.92，0.88 - 0.96）和CCTA + 视觉CT灌注（0.
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