Image quality and diagnostic accuracy of coronary CT angiography derived from low-dose dynamic CT myocardial perfusion: a feasibility study with comparison to invasive coronary angiography
Image quality and diagnostic accuracy of coronary CT angiography derived from low-dose dynamic CT myocardial perfusion: a feasibility study with comparison to invasive coronary angiography
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DOI：
10.1007/s00330-018-5777-4
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发表时间：
2019-08-01
影响因子：
5.9
通讯作者：
Zhang, Jiayin
中科院分区：
文献类型：
--
作者：
Dai, Xu;Yu, Mengmeng;Zhang, Jiayin
目的 参考第三代双源CT动态CT心肌灌注成像（CCTA（CT-MPI））冠状动脉CT血管造影（CCTA（CT-MPI）），并参考有创冠状动脉造影（ICA），探讨冠状动脉CT血管造影的诊断性能。 材料与方法 前瞻性纳入急性心肌梗死患者及成功再灌注治疗患者。以ICA的紧急检查结果为参考标准，评估CCTA（CT-MPI）检测显着冠状动脉狭窄（直径狭窄>=50%）的诊断性能。并评估CCTA（CT-MPI）的辐射剂量和图像质量。结果最终纳入26例患者352个节段进行分析。动态CT-MPI产生的CCTA(CT-MPI)平均辐射剂量为3.21.1mSv。总体而言，93.5% 的总节段是可解释的（Likert 评分 2-4），而 6.5% 的节段是不可诊断的（Likert 评分 1）。 22 例患者 84 个节段经 CCTA（CT-MPI）诊断为存在≥ 50% 狭窄，而 268 个节段无阻塞性狭窄。与ICA结果相比，基于患者、基于血管以及基于节段分析的CCTA(CT-MPI)的总体诊断准确性分别为92.3%、83.6%和85.8%。 ROC分析显示，CCTA(CT-MPI)检测>=50%狭窄的AUC在每个患者水平上为0.833，在每个血管水平上为0.843，在每个节段水平上为0.822。结论动态CT-MPI衍生的CCTA(CT-MPI)能够参考ICA准确诊断阻塞性冠状动脉狭窄。 要点中心源自动态 CT-MPI 的点 CCTA 在总节段中具有 93.5% 的诊断图像质量。与 ICA 相比，源自动态 CT-MPI 的中心点 CCTA 在诊断阻塞性 CAD 方面更为准确。中心点 CCTA重建的动态CT-MPI平均辐射剂量为3.2mSv。
ObjectivesTo investigate the diagnostic performance of coronary CT angiography derived from dynamic CT myocardial perfusion imaging (CCTA(CT-MPI)) by third-generation dual-source CT with reference to invasive coronary angiography (ICA).Materials and methodsPatients with acute myocardial infarction and those who received successful reperfusion treatment were prospectively enrolled. Emergent ICA findings were used as the reference standard to assess the diagnostic performance of CCTA(CT-MPI) for detection of significant coronary stenosis (diameter stenosis >= 50%). The radiation dose as well as image quality of CCTA(CT-MPI) was also assessed.ResultsTwenty-six patients with 352 segments were ultimately included for analysis. The mean radiation dose of CCTA(CT-MPI) generated from dynamic CT-MPI was 3.21.1mSv. Overall, 93.5% of total segments were interpretable (Likert score 2-4) whereas 6.5% segments were non-diagnostic (Likert score 1). Twenty-two patients with 84 segments were diagnosed by CCTA(CT-MPI) as having >= 50% stenosis presence, whereas 268 segments had no obstructive stenosis. Compared to ICA findings, the overall diagnostic accuracy of CCTA(CT-MPI) of patient-based and vessel-based as well segment-based analysis was 92.3%, 83.6%, and 85.8% respectively. As shown by ROC analysis, the AUC of CCTA(CT-MPI) for detection of >= 50% stenosis was 0.833 on a per-patient level, 0.843 on a per-vessel level, and 0.822 on a per-segment level.ConclusionsCCTA(CT-MPI) derived from dynamic CT-MPI was able to accurately diagnose obstructive coronary stenosis with reference to ICA.Key Points center dot CCTA derived from dynamic CT-MPI had a diagnostic image quality in 93.5% of total segments.center dot CCTA derived from dynamic CT-MPI was accurate in diagnosing obstructive CAD compared to ICA. center dot The mean radiation dose of dynamic CT-MPI for reconstruction of CCTA was 3.2mSv.