Department of Radiology, Xijing Hospital, Fourth Military Medical University, 127# West Changle Road, Xi'an 710032, Shaanxi Province, China.
Department of Cardiology, Xijing Hospital, Fourth Military Medical University, 127# West Changle Road, Xi'an 710032, Shaanxi Province, China.
Eur J Radiol. 2021 Jul;140:109740. doi: 10.1016/j.ejrad.2021.109740. Epub 2021 Apr 28.
The aim of this study was to investigate the diagnostic abilities of both pericoronary adipose tissue (PCAT) CT attenuation and volume for the predication hemodynamic significance of coronary artery stenosis as evaluated by fractional flow reserve (FFR).
Patients with ≥ 30 % in at least 1 major epicardial coronary artery were retrospectively included. Furthermore, all eligible patients underwent coronary computed tomography angiography (CCTA) and invasive coronary angiography (ICA) as well as FFR within 1 month. PCAT CT attenuation and volume around ischemic and non-ischemic coronary stenosis were measured and compared. The diagnostic accuracy of PCAT CT attenuation and volume for the identification of hemodynamically significant stenosis was determined against the reference standard of FFR ≤ 0.80.
A total of 61 patients (mean age, 57.8 years ± 11.8) with 77 vessels were included. Average PCAT CT attenuation of all vessels was -70.3 ± 7.4 HU. PCAT CT attenuation in coronary arteries with hemodynamically significant stenosis (FFR ≤ 0.80) (-65.6 ± 5.9 HU) was significantly higher than those with FFR > 0.80 (-75.3 ± 5.4 HU; p = 0.000). There was a strong correlation between FFR and PCAT CT attenuation (r = 0.64, p < 0.001). However, no significant difference in PCAT volume was observed between FFR ≤ 0.8 (5.0 ± 3.5 cm) and FFR > 0.80 (5.5 ± 3.7 cm, p = 0.511). The diagnostic accuracy was significantly higher in the combination of CCTA and PCAT CT attenuation compared with CCTA alone (area under the curve: 0.869 vs. 0.569, p < 0.001).
PCAT CT attenuation but not volume was related to the hemodynamic significance of coronary artery stenosis. For the patients with suspected coronary artery disease, after adding of PCAT CT attenuation to CCTA, the diagnostic ability for the identification of ischemic coronary stenosis was significantly improved.
本研究旨在探讨冠状动脉粥样硬化性心脏病患者的诊断能力，评估冠状动脉狭窄的血流动力学意义。
回顾性纳入至少有 1 个主要心外膜冠状动脉狭窄≥30%的患者。此外，所有符合条件的患者均在 1 个月内行冠状动脉计算机断层血管造影（CCTA）和冠状动脉造影（ICA）及血流储备分数（FFR）检查。测量并比较缺血性和非缺血性冠状动脉狭窄周围的 PCAT CT 衰减和体积。以 FFR≤0.80 为参考标准，确定 PCAT CT 衰减和体积对血流动力学意义狭窄的诊断准确性。
共纳入 61 例（平均年龄 57.8±11.8 岁）患者 77 支血管。所有血管的平均 PCAT CT 衰减值为-70.3±7.4 HU。血流动力学意义狭窄（FFR≤0.80）的冠状动脉的 PCAT CT 衰减值（-65.6±5.9 HU）明显高于 FFR>0.80 的冠状动脉（-75.3±5.4 HU；p=0.000）。FFR 与 PCAT CT 衰减之间呈强相关性（r=0.64，p<0.001）。然而，FFR≤0.80 组和 FFR>0.80 组之间的 PCAT 体积无显著差异（5.0±3.5 cm 和 5.5±3.7 cm，p=0.511）。与 CCTA 单独相比，CCTA 联合 PCAT CT 衰减的诊断准确性明显更高（曲线下面积：0.869 比 0.569，p<0.001）。
PCAT CT 衰减与冠状动脉狭窄的血流动力学意义相关，但与冠状动脉狭窄的体积无关。对于疑似冠状动脉疾病的患者，在 CCTA 基础上增加 PCAT CT 衰减后，对缺血性冠状动脉狭窄的识别能力明显提高。
