心脏计算机断层扫描定量心肌细胞外容积分数：系统评价和荟萃分析。
Cardiac Computed Tomography for Quantification of Myocardial Extracellular Volume Fraction: A Systematic Review and Meta-Analysis.
机构信息
Department of Imaging and Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA.
Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA.
出版信息
JACC Cardiovasc Imaging. 2023 Oct;16(10):1306-1317. doi: 10.1016/j.jcmg.2023.03.021. Epub 2023 May 31.
BACKGROUND
Extracellular volume (ECV) is a quantitative measure of extracellular compartment expansion, and an increase in ECV is a marker of myocardial fibrosis. Although cardiac magnetic resonance (CMR) is considered the standard imaging tool for ECV quantification, cardiac computed tomography (CT) has also been used for ECV assessment.
OBJECTIVES
The aim of this meta-analysis was to evaluate the correlation and agreement in the quantification of myocardial ECV by CT and CMR.
METHODS
PubMed and Web of Science were searched for relevant publications reporting on the use of CT for ECV quantification compared with CMR as the reference standard. The authors employed a meta-analysis using the restricted maximum-likelihood estimator with a random-effects method to estimate summary correlation and mean difference. A subgroup analysis was performed to compare the correlation and mean differences between single-energy CT (SECT) and dual-energy CT (DECT) techniques for the ECV quantification.
RESULTS
Of 435 papers, 13 studies comprising 383 patients were identified. The mean age range was 57.3 to 82 years, and 65% of patients were male. Overall, there was an excellent correlation between CT-derived ECV and CMR-derived ECV (mean: 0.90 [95% CI: 0.86-0.95]). The pooled mean difference between CT and CMR was 0.96% (95% CI: 0.14%-1.78%). Seven studies reported correlation values using SECT, and 4 studies reported those using DECT. The pooled correlation from studies utilizing DECT for ECV quantification was significantly higher compared with those with SECT (mean: 0.94 [95% CI: 0.91-0.98] vs 0.87 [95% CI: 0.80-0.94], respectively; P = 0.01). There was no significant difference in pooled mean differences between SECT vs DECT (P = 0.85).
CONCLUSIONS
CT-derived ECV showed an excellent correlation and mean difference of <1% with CMR-derived ECV. However, the overall quality of the included studies was low, and larger, prospective studies are needed to examine the accuracy and diagnostic and prognostic utility of CT-derived ECV.
背景
细胞外容积（ECV）是细胞外腔扩张的定量测量指标，ECV 的增加是心肌纤维化的标志物。虽然心脏磁共振（CMR）被认为是 ECV 定量的标准成像工具，但心脏计算机断层扫描（CT）也已用于 ECV 评估。
目的
本荟萃分析旨在评估 CT 和 CMR 定量心肌 ECV 的相关性和一致性。
方法
检索 PubMed 和 Web of Science 中关于 CT 用于 ECV 定量与 CMR 作为参考标准的相关文献。作者采用受限最大似然估计量和随机效应方法进行荟萃分析，以估计汇总相关性和平均差异。进行亚组分析以比较单能量 CT（SECT）和双能 CT（DECT）技术用于 ECV 定量的相关性和平均差异。
结果
在 435 篇论文中，确定了 13 项包含 383 名患者的研究。平均年龄范围为 57.3 至 82 岁，65%的患者为男性。总体而言，CT 衍生的 ECV 与 CMR 衍生的 ECV 之间存在极好的相关性（平均：0.90[95%置信区间：0.86-0.95]）。CT 与 CMR 之间的平均差异为 0.96%（95%置信区间：0.14%-1.78%）。7 项研究报告了使用 SECT 的相关性值，4 项研究报告了使用 DECT 的相关性值。使用 DECT 进行 ECV 定量的研究的汇总相关性明显高于使用 SECT 的研究（平均：0.94[95%置信区间：0.91-0.98]比 0.87[95%置信区间：0.80-0.94]，分别；P=0.01）。SECT 与 DECT 之间的平均差异无显著差异（P=0.85）。
结论
CT 衍生的 ECV 与 CMR 衍生的 ECV 具有极好的相关性和差异<1%。然而，纳入研究的整体质量较低，需要更大的前瞻性研究来检验 CT 衍生的 ECV 的准确性以及诊断和预后价值。
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