Automated Pixel-Wise Quantitative Myocardial Perfusion Mapping by CMR to Detect Obstructive Coronary Artery Disease and Coronary Microvascular Dysfunction: Validation Against Invasive Coronary Physiology.
Automated Pixel-Wise Quantitative Myocardial Perfusion Mapping by CMR to Detect Obstructive Coronary Artery Disease and Coronary Microvascular Dysfunction: Validation Against Invasive Coronary Physiology.
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CMR通过自动像素定量的心肌灌注映射，以检测阻塞性冠状动脉疾病和冠状动脉微血管功能障碍：针对侵入性冠状动脉生理学的验证。
DOI：
10.1016/j.jcmg.2018.12.022
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发表时间：
2019-10
期刊：
影响因子：
--
通讯作者：
Fontana M
中科院分区：
文献类型：
--
作者：
Kotecha T;Martinez-Naharro A;Boldrini M;Knight D;Hawkins P;Kalra S;Patel D;Coghlan G;Moon J;Plein S;Lockie T;Rakhit R;Patel N;Xue H;Kellman P;Fontana M
评估CMR心肌灌注标测相对于有创冠状动脉生理学参考标准检测CAD（定义为血流储备分数（FFR）≤0.80）、MVD（定义为微循环阻力指数（IMR）≥25）的性能以及区分两者的能力。稳定型心绞痛患者心外膜冠状动脉疾病（CAD）和微血管功能障碍（MVD）的鉴别仍具有挑战性。自动在线CMR灌注标测能够在临床工作流程中快速进行心肌血流量（MBF）的量化。50例稳定型心绞痛患者和15例健康志愿者在1.5T条件下进行腺苷负荷CMR，同时测定MBF和心肌灌注储备（MPR）。在随后的血管造影期间，测量了101支冠状动脉的FFR和IMR。27例为阻塞性CAD，23例为非阻塞性动脉（IMR正常7例，异常16例）。血流储备分数阳性（心外膜狭窄）区的负荷MBF（1.47± 0.48 ml/g/min）和MPR（1.75±0.60）显著低于血流储备分数阴性的IMR阳性（MVD）区（负荷MBF 2.10± 0.35 ml/g/min，MPR 2.41±0.79）和正常区（负荷MBF 2.47± 0.50 ml/g/min，MPR 2.94±0.81）。负荷MBF ≤1.94ml/g/min可准确检测局部阻塞性CAD（AUC 0.90，p<0.001）。在无局部灌注缺损的患者中，总体应力MBF<1.82ml/g/min可准确区分梗阻性3VD和MVD（AUC 0.94 p<0.001）。这种新型自动像素灌注标测技术可用于检测FFR定义的生理学显著CAD、IMR定义的MVD，并可用于区分MVD与多血管冠状动脉疾病。基于CMR的诊断算法使用灌注标测检测心外膜疾病和MVD，需要进一步的临床验证。
To assess the performance of CMR myocardial perfusion mapping against invasive coronary physiology reference standards for detecting CAD (defined by fractional flow reserve (FFR)≤0.80), MVD (defined by index of microcirculatory resistance (IMR)≥25) and the ability to differentiate between the two. Differentiation of epicardial coronary artery disease (CAD) and microvascular dysfunction (MVD) in patients with stable angina remains challenging. Automated in-line CMR perfusion mapping enables quantification of myocardial blood flow (MBF) to be performed rapidly within a clinical workflow. Fifty patients with stable angina and 15 healthy volunteers underwent adenosine stress CMR at 1.5T with quantification of MBF and myocardial perfusion reserve (MPR). FFR and IMR were measured in 101 coronary arteries during subsequent angiography. Twenty-seven patients had obstructive CAD and 23 had non-obstructed arteries (7 normal IMR, 16 abnormal IMR). FFR-positive (epicardial stenosis) areas had significantly lower stress MBF (1.47±0.48ml/g/min) and MPR (1.75±0.60) than FFR-negative IMR-positive (MVD) areas (stress MBF 2.10±0.35ml/g/min, MPR 2.41±0.79) and normal areas (stress MBF 2.47±0.50ml/g/min, MPR 2.94±0.81). Stress MBF ≤1.94ml/g/min accurately detected obstructive CAD on a regional basis (AUC 0.90, p<0.001). In patients without regional perfusion defects, global stress MBF<1.82ml/g/min accurately discriminated between obstructive 3VD and MVD (AUC 0.94 p<0.001). This novel automated pixel-wise perfusion mapping technique can be used to detect physiologically significant CAD defined by FFR, MVD defined by IMR, and can be used to differentiate MVD from multi-vessel coronary disease. A CMR-based diagnostic algorithm using perfusion mapping for detection of epicardial disease and MVD warrants further clinical validation.
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DOI：
10.1186/1532-429x-16-19
发表时间：
2014-02-24
期刊：
Journal of cardiovascular magnetic resonance : official journal of the Society for Cardiovascular Magnetic Resonance
影响因子：
--
作者：
Motwani M;Kidambi A;Sourbron S;Fairbairn TA;Uddin A;Kozerke S;Greenwood JP;Plein S
通讯作者：
Plein S
影响因子：
37.8
作者：
Cerqueira, MD;Weissman, NJ;Verani, MS
通讯作者：
Verani, MS
DOI：
10.1186/s12968-016-0270-1
发表时间：
2016-09-13
期刊：
Journal of cardiovascular magnetic resonance : official journal of the Society for Cardiovascular Magnetic Resonance
影响因子：
--
作者：
Papanastasiou G;Williams MC;Dweck MR;Alam S;Cooper A;Mirsadraee S;Newby DE;Semple SI
通讯作者：
Semple SI
影响因子：
6.4
作者：
Brown, Louise A. E.;Onciul, Sebastian C.;Plein, Sven
通讯作者：
Plein, Sven
影响因子：
6.4
作者：
Kellman, Peter;Hansen, Michael S.;Xue, Hui
通讯作者：
Xue, Hui