Nagasawa Naoki, Nakamura Satoshi, Ota Hideki, Ogawa Ryo, Nakashima Hitoshi, Hatori Naoki, Wang Yining, Kurita Tairo, Dohi Kaoru, Sakuma Hajime, Kitagawa Kakuya
Department of Radiology, Mie University Hospital, Tsu, Japan.
Department of Radiological Technology, Faculty of Health Science, Suzuka University of Medical Science, Suzuka, Japan.
Eur Radiol. 2025 May;35(5):2855-2865. doi: 10.1007/s00330-024-11136-1. Epub 2024 Oct 17.
This study aimed to investigate the relationship between microvascular status in the non-ischemic myocardium and the diagnostic performance of stress dynamic CT perfusion imaging (CTP) in detecting hemodynamically significant stenosis.
This study included 157 patients who underwent coronary computed tomography angiography (CTA), CTP, and invasive coronary angiography (ICA), including fractional flow reserve (FFR). Hemodynamically significant stenosis was defined by FFR and ICA. A relative myocardial blood flow (MBF) for each myocardial segment was normalized to the highest MBF (remote MBF) among 16 segments.
The receiver operating characteristic curve analysis for detecting hemodynamically significant stenosis at the vessel level indicated that patients with lower, intermediate, and higher remote MBF had areas under the curve (AUC) of 0.66, 0.70, and 0.80, respectively, for absolute MBF and AUCs of 0.63, 0.70, and 0.83, respectively, for relative MBF. The optimal cut-off values for absolute MBF were proportional to the levels of remote MBFs, while the ones for relative MBF were more consistent across lower to higher remote MBFs. For the patients with high remote MBF, the relative MBF demonstrated a sensitivity of 69%, specificity of 88%, and accuracy of 85% in detecting hemodynamically significant stenosis.
The microvascular status in the non-ischemic myocardium influenced the diagnostic performance of dynamic CTP and threshold values of absolute MBFs, suggesting the potential preference for relative MBF over absolute MBF in clinical settings. Dynamic CTP's quantification of MBF offers the benefit of indicating reliability in ischemia detection relative to microvascular status.
Question The relationship between microvascular status and diagnostic performance of dynamic CTP imaging has not been fully investigated. Findings The diagnostic performance of dynamic CTP and threshold values of absolute MBF were impacted by microvascular status. Clinical relevance The differences in diagnostic accuracy of dynamic CTP related to varying remote MBF values necessitate a personalized evaluation of myocardial perfusion in dynamic CTP images.
本研究旨在探讨非缺血心肌的微血管状态与应力动态CT灌注成像（CTP）检测血流动力学显著狭窄的诊断性能之间的关系。
本研究纳入了157例行冠状动脉计算机断层扫描血管造影（CTA）、CTP和有创冠状动脉造影（ICA）（包括血流储备分数（FFR））的患者。血流动力学显著狭窄由FFR和ICA定义。每个心肌节段的相对心肌血流量（MBF）以16个节段中最高的MBF（远隔MBF）进行归一化。
在血管水平检测血流动力学显著狭窄的受试者工作特征曲线分析表明，远隔MBF较低、中等和较高的患者，其绝对MBF的曲线下面积（AUC）分别为0.66、0.70和0.80，相对MBF的AUC分别为0.63、0.70和0.83。绝对MBF的最佳截断值与远隔MBF水平成比例，而相对MBF的最佳截断值在远隔MBF从低到高的范围内更为一致。对于远隔MBF高的患者，相对MBF在检测血流动力学显著狭窄方面的敏感性为69%，特异性为88%，准确性为85%。
非缺血心肌的微血管状态影响动态CTP的诊断性能和绝对MBF的阈值，提示在临床环境中相对MBF可能比绝对MBF更具优势。动态CTP对MBF的量化有助于显示相对于微血管状态在缺血检测中的可靠性。
问题 微血管状态与动态CTP成像诊断性能之间的关系尚未得到充分研究。发现 动态CTP的诊断性能和绝对MBF的阈值受微血管状态影响。临床意义 动态CTP诊断准确性因远隔MBF值不同而存在差异，这需要对动态CTP图像中的心肌灌注进行个性化评估。
