动态CT心肌灌注:功能评估在冠状动脉疾病诊断中的作用
Dynamic CT Myocardial Perfusion: The Role of Functional Evaluation in the Diagnosis of Coronary Artery Disease.
作者信息
Zdanowicz Agata, Guzinski Maciej, Pula Michal, Witkowska Agnieszka, Reczuch Krzysztof
机构信息
Department of General Radiology, Interventional Radiology and Neuroradiology, Wroclaw Medical University, Borowska 213, 50-556 Wroclaw, Poland.
Lower Silesian Oncology, Pulmonology and Hematology Center, Hirszfelda Square 12, 53-413 Wroclaw, Poland.
出版信息
J Clin Med. 2023 Nov 13;12(22):7062. doi: 10.3390/jcm12227062.
Coronary computed tomography angiography (CTA) is a widely accepted, non-invasive diagnostic modality for the evaluation of patients with suspected coronary artery disease (CAD). However, a limitation of CTA is its inability to provide information on the hemodynamic significance of the coronary lesion. The recently developed stress dynamic CT perfusion technique has emerged as a potential solution to this diagnostic challenge. Dynamic CT myocardial perfusion provides information on the hemodynamic consequences of coronary stenosis and is used to detect myocardial ischemia. The combination of stress dynamic CT myocardial perfusion with CTA provides a comprehensive assessment that integrates anatomical and functional information. CT myocardial perfusion has been validated in several clinical studies and has shown comparable accuracy to Positron Emission Tomography (PET) and stress magnetic resonance imaging (MRI) in the diagnosis of hemodynamically significant coronary stenosis and superior performance to Single Photon Emission Computed Tomography (SPECT). More importantly, CTP-derived myocardial perfusion has been shown to have a strong correlation with FFR, and the use of CTP results in a reduction of negative catheterizations. In the context of suspected stable coronary artery disease, the CT protocol with dynamic perfusion imaging combined with CTA eliminates the need for additional testing, making it a convenient "one-stop-shop" method and an effective gatekeeper to an invasive approach.
冠状动脉计算机断层扫描血管造影(CTA)是一种广泛接受的、用于评估疑似冠状动脉疾病(CAD)患者的非侵入性诊断方法。然而,CTA的一个局限性在于其无法提供有关冠状动脉病变血流动力学意义的信息。最近开发的应力动态CT灌注技术已成为应对这一诊断挑战的潜在解决方案。动态CT心肌灌注可提供有关冠状动脉狭窄血流动力学后果的信息,并用于检测心肌缺血。应力动态CT心肌灌注与CTA相结合可提供综合评估,整合解剖学和功能信息。CT心肌灌注已在多项临床研究中得到验证,在诊断具有血流动力学意义的冠状动脉狭窄方面,其准确性与正电子发射断层扫描(PET)和应力磁共振成像(MRI)相当,且性能优于单光子发射计算机断层扫描(SPECT)。更重要的是,CTP衍生的心肌灌注已被证明与FFR有很强的相关性,使用CTP可减少阴性导管插入术。在疑似稳定冠状动脉疾病的情况下,结合动态灌注成像和CTA的CT方案无需额外检测,使其成为一种方便的“一站式”方法,也是侵入性方法的有效把关手段。
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