利用动态心肌灌注 CT 的分形分析区分大血管和微血管缺血。
Differentiating Macrovascular and Microvascular Ischemia Using Fractal Analysis of Dynamic Myocardial Perfusion Stress-CT.
机构信息
From the Department of Radiology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany (F.M., M.D.); Department of Advanced Diagnostic Imaging, Mie University Graduate School of Medicine, Tsu, Japan (F.M., K.K.); Department of Radiology, Mie University Graduate School of Medicine, Tsu, Japan (S.N., H.S.); Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, Tsu, Japan (T.K.); Department of Advanced MRI Collaborative Research, Tohoku University Graduate School of Medicine, Sendai, Japan (H.O.); Department of Cardiology, Tohoku University Graduate School of Medicine, Sendai, Japan (K.N.); Saiseikai Matsuyama Hospital, Matsuyama, Japan (R.O.); Takasaki General Medical Center, Takasaki, Japan (T.S.); National Hospital Organization Kagoshima Medical Center, Kagoshima, Japan (H.N.); Peking Union Medical College Hospital, Beijing, China (Y.-N.W.); Kobe University Graduate School of Medicine, Kobe, Japan (T.I.); German Center for Cardiovascular Research, Berlin, Germany (M.D.); and Deutsches Herzzentrum der Charité (M.D.), Berlin, Germany.
出版信息
Invest Radiol. 2024 May 1;59(5):413-423. doi: 10.1097/RLI.0000000000001027. Epub 2023 Oct 9.
OBJECTIVES
Fractal analysis of dynamic myocardial stress computed tomography perfusion imaging (4D-CTP) has shown potential to noninvasively differentiate obstructive coronary artery disease (CAD) and coronary microvascular disease (CMD). This study validates fractal analysis of 4D-CTP in a multicenter setting and assesses its diagnostic accuracy in subgroups with ischemia and nonobstructed coronary arteries (INOCA) and with mild to moderate stenosis.
MATERIALS AND METHODS
From the AMPLIFiED multicenter trial, patients with suspected or known chronic myocardial ischemia and an indication for invasive coronary angiography were included. Patients underwent dual-source CT angiography, 4D-CTP, and CT delayed-enhancement imaging. Coronary artery disease, CMD, and normal perfusion were defined by a combined reference standard comprising invasive coronary angiography with fractional flow reserve, and absolute or relative CT-derived myocardial blood flow. Nonobstructed coronary arteries were defined as ≤25% stenosis and mild to moderate stenosis as 26%-80%.
RESULTS
In 127 patients (27% female), fractal analysis accurately differentiated CAD (n = 61, 23% female), CMD (n = 23, 30% female), and normal perfusion (n = 34, 35% female) with a multiclass area under the receiver operating characteristic curve (AUC) of 0.92 and high agreement (multiclass κ = 0.89). In patients with ischemia (n = 84), fractal analysis detected CAD (n = 61) over CMD (n = 23) with sensitivity of 95%, specificity of 74%, accuracy of 89%, and AUC of 0.83. In patients with nonobstructed coronary arteries (n = 33), INOCA (n = 15) was detected with sensitivity of 100%, specificity of 78%, accuracy of 88%, and AUC of 0.94. In patients with mild to moderate stenosis (n = 27), fractal analysis detected CAD (n = 19) over CMD with sensitivity of 84%, specificity of 100%, accuracy of 89%, and AUC of 0.95.
CONCLUSIONS
In this multicenter study, fractal analysis of 4D-CTP accurately differentiated CAD and CMD including subgroups with INOCA and with mild to moderate stenosis.
目的
动态心肌应力计算机断层灌注成像（4D-CTP）的分形分析已显示出能够无创地区分阻塞性冠状动脉疾病（CAD）和冠状动脉微血管疾病（CMD）的潜力。本研究在多中心环境中验证了 4D-CTP 的分形分析，并评估了其在有缺血和无阻塞性冠状动脉（INOCA）以及轻度至中度狭窄的亚组中的诊断准确性。
材料和方法
本研究纳入了来自 AMPLIFiED 多中心试验的疑似或已知慢性心肌缺血且有行冠状动脉造影指征的患者。患者接受了双源 CT 血管造影、4D-CTP 和 CT 延迟增强成像。CAD、CMD 和正常灌注通过包括有血流储备分数的有创冠状动脉造影以及绝对或相对 CT 衍生心肌血流的综合参考标准来定义。无阻塞性冠状动脉定义为≤25%狭窄，轻度至中度狭窄定义为 26%-80%。
结果
在 127 例患者（27%为女性）中，分形分析准确地区分了 CAD（n=61，23%为女性）、CMD（n=23，30%为女性）和正常灌注（n=34，35%为女性），多类受试者工作特征曲线（ROC）下面积（AUC）为 0.92，一致性较高（多类 κ=0.89）。在有缺血的患者（n=84）中，分形分析检测到了 CAD（n=61）而非 CMD（n=23），其敏感性为 95%，特异性为 74%，准确性为 89%，AUC 为 0.83。在无阻塞性冠状动脉的患者（n=33）中，INOCA（n=15）的检测敏感性为 100%，特异性为 78%，准确性为 88%，AUC 为 0.94。在轻度至中度狭窄的患者（n=27）中，分形分析检测到了 CAD（n=19）而非 CMD，其敏感性为 84%，特异性为 100%，准确性为 89%，AUC 为 0.95。
结论
在这项多中心研究中，4D-CTP 的分形分析准确地区分了 CAD 和 CMD，包括 INOCA 和轻度至中度狭窄的亚组。
Zotero 插件