毫米级高分辨率非对比增强冠状动脉磁共振血管造影与冠状动脉 CT 血管造影在低中度冠状动脉疾病风险患者中的临床比较：一项单中心试验。
Clinical comparison of sub-mm high-resolution non-contrast coronary CMR angiography against coronary CT angiography in patients with low-intermediate risk of coronary artery disease: a single center trial.
机构信息
School of Biomedical Engineering and Imaging Sciences, King's College London, 3rdfloor Lambeth Wing, London, SE1 7EH, UK.
Department of Cardiology, Guy's and St Thomas' NHS Foundation Trust, London, UK.
出版信息
J Cardiovasc Magn Reson. 2021 May 17;23(1):57. doi: 10.1186/s12968-021-00758-9.
BACKGROUND
The widespread clinical application of coronary cardiovascular magnetic resonance (CMR) angiography (CMRA) for the assessment of coronary artery disease (CAD) remains limited due to low scan efficiency leading to prolonged and unpredictable acquisition times; low spatial-resolution; and residual respiratory motion artefacts resulting in limited image quality. To overcome these limitations, we have integrated highly undersampled acquisitions with image-based navigators and non-rigid motion correction to enable high resolution (sub-1 mm) free-breathing, contrast-free 3D whole-heart coronary CMRA with 100% respiratory scan efficiency in a clinically feasible and predictable acquisition time.
OBJECTIVES
To evaluate the diagnostic performance of this coronary CMRA framework against coronary computed tomography angiography (CTA) in patients with suspected CAD.
METHODS
Consecutive patients (n = 50) with suspected CAD were examined on a 1.5T CMR scanner. We compared the diagnostic accuracy of coronary CMRA against coronary CTA for detecting a ≥ 50% reduction in luminal diameter.
RESULTS
The 50 recruited patients (55 ± 9 years, 33 male) completed coronary CMRA in 10.7 ± 1.4 min. Twelve (24%) had significant CAD on coronary CTA. Coronary CMRA obtained diagnostic image quality in 95% of all, 97% of proximal, 97% of middle and 90% of distal coronary segments. The sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy were: per patient (100%, 74%, 55%, 100% and 80%), per vessel (81%, 88%, 46%, 97% and 88%) and per segment (76%, 95%, 44%, 99% and 94%) respectively.
CONCLUSIONS
The high diagnostic image quality and diagnostic performance of coronary CMRA compared against coronary CTA demonstrates the potential of coronary CMRA as a robust and safe non-invasive alternative for excluding significant disease in patients at low-intermediate risk of CAD.
背景
由于扫描效率低导致采集时间延长且不可预测、空间分辨率低以及残留呼吸运动伪影导致图像质量有限，冠状动脉心血管磁共振（CMR）血管造影（CMRA）在评估冠状动脉疾病（CAD）中的广泛临床应用仍然受到限制。为了克服这些限制，我们将欠采样采集与基于图像的导航仪和非刚性运动校正相结合，以便在临床可行且可预测的采集时间内实现具有 100%呼吸扫描效率的高分辨率（亚 1mm）自由呼吸、无对比剂的 3D 全心冠状动脉 CMRA。
目的
评估该冠状动脉 CMRA 框架与冠状动脉计算机断层血管造影（CTA）在疑似 CAD 患者中的诊断性能。
方法
连续 50 例疑似 CAD 的患者在 1.5T CMR 扫描仪上进行检查。我们比较了冠状动脉 CMRA 与冠状动脉 CTA 在检测管腔直径减少≥50%方面的诊断准确性。
结果
50 名入组患者（55±9 岁，33 名男性）在 10.7±1.4 分钟内完成了冠状动脉 CMRA。12 例（24%）冠状动脉 CTA 显示有显著 CAD。冠状动脉 CMRA 在所有节段中获得了 95%的诊断图像质量，在近端节段中为 97%，在中段为 97%，在远段为 90%。每位患者的敏感性、特异性、阳性预测值、阴性预测值和诊断准确性分别为：100%、74%、55%、100%和 80%，每支血管为 81%、88%、46%、97%和 88%，每个节段为 76%、95%、44%、99%和 94%。
结论
与冠状动脉 CTA 相比，冠状动脉 CMRA 的高诊断图像质量和诊断性能表明，冠状动脉 CMRA 具有成为一种强大且安全的非侵入性替代方法的潜力，可用于排除 CAD 低-中度风险患者的显著疾病。
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