动态应力 CT 灌注成像的分形分析在检测与血流动力学相关的冠状动脉疾病中的应用。
Fractal Analysis of Dynamic Stress CT-Perfusion Imaging for Detection of Hemodynamically Relevant Coronary Artery Disease.
机构信息
Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Radiology, Berlin, Germany.
Department of Radiology, Mie University Graduate School of Medicine, Tsu, Japan.
出版信息
JACC Cardiovasc Imaging. 2022 Sep;15(9):1591-1601. doi: 10.1016/j.jcmg.2022.03.015. Epub 2022 May 11.
BACKGROUND
Combined computed tomography-derived myocardial blood flow (CTP-MBF) and computed tomography angiography (CTA) has shown good diagnostic performance for detection of coronary artery disease (CAD). However, fractal analysis might provide additional insight into ischemia pathophysiology by characterizing multiscale perfusion patterns and, therefore, may be useful in diagnosing hemodynamically significant CAD.
OBJECTIVES
The purpose of this study was to investigate, in a multicenter setting, whether fractal analysis of perfusion improves detection of hemodynamically relevant CAD over myocardial blood flow quantification (CTP-MBF) using dynamic, 4-dimensional, dynamic stress myocardial computed tomography perfusion (CTP) imaging.
METHODS
In total, 7 centers participating in the prospective AMPLIFiED (Assessment of Myocardial Perfusion Linked to Infarction and Fibrosis Explored with Dual-source CT) study acquired CTP and CTA data in patients with suspected or known CAD. Hemodynamically relevant CAD was defined as ≥90% stenosis on invasive coronary angiography or fractional flow reserve <0.80. Both fractal analysis and CTP-MBF quantification were performed on CTP images and were combined with CTA results.
RESULTS
This study population included 127 participants, among them 61 patients, or 79 vessels, with CAD as per invasive reference standard. Compared with the combination of CTP-MBF and CTA, combined fractal analysis and CTA improved sensitivity on the per-patient level from 84% (95% CI: 72%-92%) to 95% (95% CI: 86%-99%; P = 0.01) and specificity from 70% (95% CI: 57%-82%) to 89% (95% CI: 78%-96%; P = 0.02). The area under the receiver-operating characteristic curve improved from 0.83 (95% CI: 0.75-0.90) to 0.92 (95% CI: 0.86-0.98; P = 0.01).
CONCLUSIONS
Fractal analysis constitutes a quantitative and pathophysiologically meaningful approach to myocardial perfusion analysis using dynamic stress CTP, which improved diagnostic performance over CTP-MBF when combined with anatomical information from CTA.
背景
联合计算机断层扫描（CT）衍生的心肌血流（CTP-MBF）和计算机断层血管造影（CTA）已显示出良好的诊断性能，可用于检测冠状动脉疾病（CAD）。然而，分形分析通过对多尺度灌注模式进行特征描述，可能为缺血性病理生理学提供更多的见解，因此可能有助于诊断血流动力学相关的 CAD。
目的
本研究旨在探讨在多中心环境中，与心肌血流定量（CTP-MBF）相比，使用动态、4 维、动态压力心肌计算机断层灌注（CTP）成像的灌注分形分析是否能提高对血流动力学相关 CAD 的检测能力。
方法
共有 7 个中心参与了前瞻性 AMPLIFiED（评估与双源 CT 相关的心肌灌注与纤维化）研究，对疑似或已知 CAD 的患者进行了 CTP 和 CTA 数据采集。血流动力学相关 CAD 的定义为血管内造影检查≥90%狭窄或血流储备分数（FFR）<0.80。分形分析和 CTP-MBF 定量均在 CTP 图像上进行，并与 CTA 结果相结合。
结果
该研究人群包括 127 名参与者，其中 61 名患者或 79 个血管，根据血管内参考标准，CAD 的患病率为 61%。与 CTP-MBF 和 CTA 联合相比，联合分形分析和 CTA 提高了患者层面的敏感度，从 84%（95%CI：72%-92%）提高到 95%（95%CI：86%-99%；P=0.01），特异性从 70%（95%CI：57%-82%）提高到 89%（95%CI：78%-96%；P=0.02）。受试者工作特征曲线下面积从 0.83（95%CI：0.75-0.90）提高到 0.92（95%CI：0.86-0.98；P=0.01）。
结论
分形分析是一种使用动态压力 CTP 进行心肌灌注分析的定量和病理生理学上有意义的方法，与 CTA 提供的解剖学信息相结合，可提高 CTP-MBF 的诊断性能。
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