计算机断层扫描心肌灌注成像容积定量的增值。
Incremental value of volumetric quantification for myocardial perfusion imaging by computed tomography.
机构信息
Department of Intensive Cardiac Therapy, National Institute of Cardiology, Warszawa, Poland.
Department of Coronary and Structural Heart Diseases, National Institute of Cardiology, Warszawa, Poland.
出版信息
Kardiol Pol. 2022;80(2):163-171. doi: 10.33963/KP.a2022.0015. Epub 2022 Jan 18.
UNLABELLED
ackground: The extent of myocardial ischemia is the crucial prognostic factor for interventional treatment decision making for coronary artery disease. The ability of computed tomography per-fusion (CTP) to provide the missing volumetric information and its clinical value remains unknown.
AIMS
The study aimed to compare a novel ischemic volume quantification method based on dynamic computed tomography perfusion (VOL CTP) with other CT-based imaging modalities for revascularization prediction.
METHODS
In this prospective study, 53 (25 females, 63.5 [8.5] years old) consecutive symptomatic patients with 50%-90% coronary artery stenosis (n ≥1) on coronary computed tomography angiography underwent computed-tomography-derived fractional flow reserve (CT-FFR) analysis and dynamic CTP. We calculated the percentage of myocardial ischemia on the CTP-derived images. A 10% cut-off was used to define functionally significant ischemia. The outcomes include coronary revas-cularization during the follow-up of 2.5 (interquartile range, 1.4-2.8) years. Physicians were blinded to the results of CTP and CT-FFR.
RESULTS
Of the 53 patients in the study (68 arteries with 50%-90% stenosis), 16 underwent revascularization (12 elective, 4 event-driven). In the CTP quantitative analysis, 26 patients had ischemia. Overall, 18 patients had ischemia ≥10% on volumetric ischemia quantification based on dynamic computed tomography perfusion (VOL CTP), and 28 patients had CT-FFR <0.8. VOL CTP, standard CTP, CT-FFR, and computed tomography coronary angiography (CTA) ≥70% performed well for the prediction of total revascularization. Area under the curve was 0.973 vs. 0.865, vs. 0.793, vs. 0.668, respectively. The VOL CTP with ≥10% cut-off was superior to the CT-FFR, standard CTP, and CTA ≥70% (P <0.001; P = 0.002 and P <0.001 respectively).
CONCLUSIONS
VOL CTP quantification is feasible and adds important, actionable information to that provided by standard CTP or CT-FFR in patients with 50%-90% coronary artery stenosis.
目的
本研究旨在比较一种新的基于动态计算机断层灌注（VOL CTP）的缺血容积量化方法与其他 CT 成像方式在预测血运重建方面的差异。
方法
在这项前瞻性研究中，53 例（25 名女性，63.5[8.5]岁）症状性患者连续行冠状动脉计算机断层血管造影术（CTA）检查，结果显示存在 50%-90%的冠状动脉狭窄（n≥1），并接受了计算机断层血流储备分数（CT-FFR）分析和动态 CTP。我们计算了 CTP 图像上的心肌缺血百分比。使用 10%的截断值来定义有功能意义的缺血。主要结局是在 2.5 年（四分位距 1.4-2.8）的随访期间进行冠状动脉血运重建。医生对 CTP 和 CT-FFR 的结果均不知情。
结果
在这项研究的 53 例患者中（68 支存在 50%-90%狭窄的血管），16 例患者接受了血运重建（12 例择期，4 例紧急）。在 CTP 定量分析中，26 例患者存在缺血。总体而言，在基于动态计算机断层灌注的容积缺血定量分析中，18 例患者的缺血程度≥10%，28 例患者的 CT-FFR<0.8。对于总血运重建的预测，VOL CTP、标准 CTP、CT-FFR 和 CT 冠状动脉造影（CTA）≥70%的曲线下面积分别为 0.973、0.865、0.793 和 0.668。VOL CTP 缺血程度≥10%的预测效果优于 CT-FFR、标准 CTP 和 CTA≥70%（P<0.001；P=0.002 和 P<0.001）。
结论
VOL CTP 定量分析是可行的，并且在存在 50%-90%冠状动脉狭窄的患者中，它比标准 CTP 或 CT-FFR 提供了更重要的、可操作的信息。
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