Peak enhancement ratio of myocardium to aorta for identification of myocardial ischemia using dynamic myocardial computed tomography perfusion imaging
Peak enhancement ratio of myocardium to aorta for identification of myocardial ischemia using dynamic myocardial computed tomography perfusion imaging
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DOI：
10.1016/j.jjcc.2017.04.002
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发表时间：
2017-11-01
影响因子：
2.5
通讯作者：
Mochizuki, Teruhito
中科院分区：
文献类型：
--
作者：
Tanabe, Yuki;Kido, Teruhito;Mochizuki, Teruhito
背景资料：本研究旨在评价动态CT心肌灌注成像（CTP）的心肌与主动脉峰值增强（PE）比（PER）在磁共振（MR）诊断心肌缺血中的应用价值。从时间衰减曲线，心肌PE，PER，和心肌血流量（MBF）计算基于段的分析。采用斯皮尔曼相关分析评价心肌PE与主动脉PE的相关性，采用Mann-Whitney U检验评价心肌PE和PER在正常和缺血心肌间的差异。结果：在704个心肌节段中，MR诊断心肌缺血258个节段（37%）。心肌和主动脉PE在正常和缺血节段中均显著相关（r = 0.76和0.58; p < 0.05）。缺血节段心肌PE、PER均显著低于正常节段（均P < 0.05）。心肌PE的敏感性和特异性分别为61% [95%置信区间（CI），55-70%]和83%（95% CI，73-87%），PER为78%（67-88%）和82%（95% CI，70-91%），MBF为81%（95% CI，73-87%）和85%（95% CI，79-92%）。PER（0.87; 95% CI，0.84-0.90）和MBF（0.88; 95% CI，0.85-0.91）的曲线下面积显著大于心肌PE（0.75; 95% CI，0.70-0.79）（均为p < 0.05）。PER与MBF的曲线下面积无显著性差异。结论：PER半定量参数对心肌缺血的诊断准确率较高，与MBF相当。(C)2017年日本心脏病学院。由爱思唯尔有限公司出版。保留所有权利。
Background: This study aimed to evaluate the feasibility of peak enhancement (PE) ratio of myocardium to aorta (PER) derived from stress dynamic computed tomography myocardial perfusion imaging (CTP) for the detection of myocardial ischemia assessed by magnetic resonance (MR) imaging.Methods: Forty-four patients who underwent stress dynamic CTP and MR imaging were retrospectively evaluated. From the time-attenuation curve, myocardial PE, PER, and myocardial blood flow (MBF) were calculated on a segment-based analysis. The correlation between myocardial and aortic PE was assessed by Spearman's correlation, and the differences in myocardial PE and PER between normal and ischemic myocardium were assessed by the Mann-Whitney U-test. The diagnostic accuracies of myocardial PE, PER, and MBF for detecting myocardial ischemia were compared by receiver operating characteristic analysis.Results: Of 704 segments, 258 segments (37%) were diagnosed as myocardial ischemia with MR imaging. Myocardial and aortic PE were significantly correlated in both normal and ischemic segments (r = 0.76 and 0.58; p < 0.05, in each). The myocardial PE and PER of ischemic segments were significantly lower than those of normal segments (p < 0.05, in each). Sensitivity and specificity were 61% [95% confidence interval (CI), 55-70%] and 83% (95% CI, 73-87%) for myocardial PE, 78% (67-88%) and 82% (95% CI, 70-91%) for PER, and 81% (95% CI, 73-87%) and 85% (95% CI, 79-92%) for MBF. There was a significantly larger area under the curve for PER (0.87; 95% CI, 0.84-0.90) and MBF (0.88; 95% CI, 0.85-0.91), compared to myocardial PE (0.75; 95% CI, 0.70-0.79) (p < 0.05, in each). There was no significant difference in area under the curve between PER and MBF.Conclusions: The semi-quantitative parameter of PER showed a high diagnostic accuracy for the detection of myocardial ischemia, comparable to that of MBF. (C) 2017 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.