Ruiz-Muñoz Aroa, Valente Filipa, Dux-Santoy Lydia, Guala Andrea, Teixidó-Turà Gisela, Galián-Gay Laura, Gutiérrez Laura, Fernández-Galera Rubén, Casas Guillem, González-Alujas Teresa, Ferreira-González Ignacio, Evangelista Arturo, Rodríguez-Palomares José
Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain.
CIBER-CV, Instituto de Salud Carlos III, Madrid, Spain.
Int J Cardiol Heart Vasc. 2021 Feb 4;32:100721. doi: 10.1016/j.ijcha.2021.100721. eCollection 2021 Feb.
To compare performance of visual and quantitative analyses for detecting myocardial ischaemia from single- and dual-energy computed tomography (CT) in patients with suspected coronary artery disease (CAD).
Eighty-four patients with suspected CAD were scheduled for dual-energy cardiac CT at rest (CTA) and pharmacological stress (CTP). Myocardial CT perfusion was analysed visually and using three parameters: mean attenuation density (MA), transmural perfusion ratio (TPR) and myocardial perfusion reserve index (MPRI), on both single-energy CT and CT-based iodine images. Significant CAD was defined in AHA-segments by concomitant myocardial hypoperfusion identified visually or quantitatively (parameter < threshold) and coronary stenosis detected by CTA. Single-photon emission CT and invasive coronary angiography were used as reference. Perfusion-parameter cut-off values were calculated in a randomly-selected subgroup of 30 patients.
The best-performing thresholds for TPR, MPRI and MA were 0.96, 23 and 0.5 for single-energy CT and 0.97, 47 and 0.3 for iodine imaging. For both CT-imaging modalities, TPR yielded the highest area under receiver operating characteristic curve (AUC) (0.99 and 0.97 for single-energy CT and iodine imaging, respectively, in vessel-based analysis) compared to visual analysis, MA and MPRI. Visual interpretation on iodine imaging resulted in higher AUC compared to that on single-energy CT in per-vessel (AUC: 0.93 vs 0.86, respectively) and per-patient (0.94 vs 0.93) analyses.
Transmural perfusion ratio on both CT-imaging modalities is the best-performing parameter for detecting myocardial ischaemia compared to visual method and other perfusion parameters. Visual analysis on CT-based iodine imaging outperforms that on single-energy CT.
比较视觉分析和定量分析在疑似冠状动脉疾病（CAD）患者中通过单能量和双能量计算机断层扫描（CT）检测心肌缺血的性能。
84例疑似CAD患者计划进行静息双能量心脏CT（CTA）和药物负荷（CTP）检查。对单能量CT和基于CT的碘图像进行心肌CT灌注的视觉分析，并使用三个参数：平均衰减密度（MA）、透壁灌注率（TPR）和心肌灌注储备指数（MPRI）。通过视觉或定量（参数<阈值）识别的伴随心肌灌注不足以及CTA检测到的冠状动脉狭窄，在AHA节段中定义显著CAD。采用单光子发射CT和有创冠状动脉造影作为参考。在随机选择的30例患者亚组中计算灌注参数截断值。
单能量CT的TPR、MPRI和MA的最佳性能阈值分别为0.96、23和0.5，碘成像的最佳性能阈值分别为0.97、47和0.3。对于两种CT成像方式，与视觉分析、MA和MPRI相比，TPR在基于血管的分析中产生的受试者操作特征曲线下面积（AUC）最高（单能量CT和碘成像分别为0.99和0.97）。在基于血管（AUC：分别为0.93和0.86）和基于患者（0.94和0.93）的分析中，碘成像的视觉解读比单能量CT产生更高的AUC。
与视觉方法和其他灌注参数相比，两种CT成像方式的透壁灌注率是检测心肌缺血的最佳性能参数。基于CT的碘成像的视觉分析优于单能量CT。
