Diagnostic accuracy of stress perfusion CMR in comparison with quantitative coronary angiography: fully quantitative, semiquantitative, and qualitative assessment.
Diagnostic accuracy of stress perfusion CMR in comparison with quantitative coronary angiography: fully quantitative, semiquantitative, and qualitative assessment.
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DOI：
10.1016/j.jcmg.2013.08.014
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发表时间：
2014-01
影响因子：
14
通讯作者：
Arai, Andrew E.
中科院分区：
文献类型：
--
作者：
Mordini, Federico E.;Haddad, Tariq;Hsu, Li-Yueh;Kellrnan, Peter;Lowrey, Tracy B.;Aletras, Anthony H.;Bandettini, Patricia;Arai, Andrew E.
关键词：
我们的主要目的是确定与定量冠状动脉造影（QCA）的参考标准相比，完全定量负荷灌注CMR的灵敏度，特异性和准确性。我们假设，负荷灌注CMR的全定量分析在识别显著冠状动脉狭窄方面具有较高的诊断准确性，并超过灌注和定性解释的半定量测量的准确性。相对较少的研究应用全定量CMR灌注测量冠心病患者和半定量和定性方法的比较是有限的。对67例有心肌缺血临床指征的患者进行双推注潘生丁负荷灌注CMR检查。采用全定量方法（QP）和对比增强率（CER）、上斜率指数（SLP）和上斜率积分（INT）3种半定量方法分析单独的负荷灌注图像。采用杜克算法和标准临床解释两种方法对综合检查（电影成像、负荷/静息灌注、晚期钆增强）进行定性分析。QCA显示的70%或以上狭窄被视为异常。受试者工作特征曲线确定的QP最佳诊断阈值为心内膜流量小于平均心外膜流量的50%，敏感性为87%，特异性为93%。QP的曲线下面积（AUC）为0.92，上级半定量方法：CER 0.78、SLP 0.82和INT 0.75（分别为p=0.011、p=0.019、p=0.004 vs QP）。QP的AUC也上级定性方法：杜克算法0.70和临床解释0.78（分别与QP相比p<0.001和p<0.001）。完全定量负荷灌注CMR对检测阻塞性CAD具有较高的诊断准确性。QP优于灌注的半定量测量和结合电影、灌注和晚期钆增强成像的定性方法。这些发现表明定量负荷灌注CMR的潜在临床作用。
Our primary objective was to determine the sensitivity, specificity, and accuracy of fully quantitative stress perfusion CMR versus a reference standard of quantitative coronary angiography (QCA). We hypothesized that fully quantitative analysis of stress perfusion CMR would have high diagnostic accuracy for identifying significant coronary artery stenosis and exceed the accuracy of semi-quantitative measures of perfusion and qualitative interpretation. Relatively few studies apply fully quantitative CMR perfusion measures to patients with coronary disease and comparisons to semi-quantitative and qualitative methods are limited. Dual bolus dipyridamole stress perfusion CMR exams were performed in 67 patients with clinical indications for assessment of myocardial ischemia. Stress perfusion images alone were analyzed with a fully quantitative method (QP) and 3 semi-quantitative methods including contrast enhancement ratio (CER), upslope index (SLP), and upslope integral (INT). Comprehensive exams (cine imaging, stress/rest perfusion, late gadolinium enhancement) were analyzed qualitatively with two methods including the Duke Algorithm and standard clinical interpretation. A 70% or greater stenosis by QCA was considered abnormal. The optimum diagnostic threshold for QP determined by receiver operating characteristic curve occurred when endocardial flow decreased to <50% of mean epicardial flow which yielded a sensitivity of 87% and specificity of 93%. The area under the curve (AUC) for QP was 0.92 which was superior to semi-quantitative methods: CER 0.78, SLP 0.82, and INT 0.75 (p=0.011, p=0.019, p=0.004 versus QP, respectively). AUC for QP was also superior to qualitative methods: Duke Algorithm 0.70 and clinical interpretation 0.78 (p<0.001 and p<0.001 versus QP, respectively). Fully quantitative stress perfusion CMR has high diagnostic accuracy for detecting obstructive CAD. QP outperforms semi-quantitative measures of perfusion and qualitative methods that incorporate a combination of cine, perfusion, and late gadolinium enhancement imaging. These findings suggest a potential clinical role for quantitative stress perfusion CMR.
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