Coronary artery stenosis-related perfusion ratio using dynamic computed tomography myocardial perfusion imaging: a pilot for identification of hemodynamically significant coronary artery disease
Coronary artery stenosis-related perfusion ratio using dynamic computed tomography myocardial perfusion imaging: a pilot for identification of hemodynamically significant coronary artery disease
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DOI：
10.1007/s12928-019-00627-4
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发表时间：
2019-10
影响因子：
3.2
通讯作者：
Natsumi Kuwahara;Y. Tanabe;T. Kido;A. Kurata;T. Uetani;Hitomi Ochi;N. Kawaguchi;T. Kido;S. Ikeda;Osamu Yamaguchi;M. Asano;T. Mochizuki
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文献类型：
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作者：
Natsumi Kuwahara;Y. Tanabe;T. Kido;A. Kurata;T. Uetani;Hitomi Ochi;N. Kawaguchi;T. Kido;S. Ikeda;Osamu Yamaguchi;M. Asano;T. Mochizuki
本研究的目的是评价狭窄相关定量灌注比（QPR）检测血流动力学显著冠状动脉疾病（CAD）的可行性。回顾性入组了27例患者。所有患者均接受了动态心肌计算机断层扫描灌注（CTP）和冠状动脉计算机断层扫描血管造影（CTA），然后进行了有创冠状动脉造影（伊卡），测量血流储备分数（FFR）。FFR ≤ 0.8的冠状动脉病变定义为血流动力学显著CAD。使用动态CTP数据计算心肌血流量（MBF），CT-QPR计算为CT-MBF相对于参考CT-MBF。使用基于Voronoi图的心肌分割从冠状动脉CTA数据计算狭窄相关的CT-MBF和QPR。评价了FFR与狭窄相关CT-MBF或QPR之间的关系以及狭窄相关CT-MBF和QPR的诊断性能。在81条血管中，测量了39条血管的FFR，15例患者的20条血管（51%）被诊断为血流动力学显著CAD。狭窄相关的CT-QPR（r= 0.70，p < 0.05）较CT-MBF（r= 0.56，p < 0.05）相关性好。CT-MBF检测血流动力学显著CAD的敏感性和特异性分别为95%和58%，CT-QPR分别为95%和90%。CT-QPR的受试者工作特征曲线下面积显著高于CT-MBF（0.94 vs. 0.79;p< 0.05）。来自动态心肌CTP和冠状动脉CTA的狭窄相关CT-QPR显示出与FFR更好的相关性，并且与狭窄相关CT-MBF相比，在检测血流动力学显著CAD方面具有更高的诊断性能。
The purpose of this study was to evaluate the feasibility of the stenosis-related quantitative perfusion ratio (QPR) for detecting hemodynamically significant coronary artery disease (CAD). Twenty-seven patients were retrospectively enrolled. All patients underwent dynamic myocardial computed tomography perfusion (CTP) and coronary computed tomography angiography (CTA) before invasive coronary angiography (ICA) measuring the fractional flow reserve (FFR). Coronary lesions with FFR ≤ 0.8 were defined as hemodynamically significant CAD. The myocardial blood flow (MBF) was calculated using dynamic CTP data, and CT-QPR was calculated as the CT-MBF relative to the reference CT-MBF. The stenosis-related CT-MBF and QPR were calculated using Voronoi diagram-based myocardial segmentation from coronary CTA data. The relationships between FFR and stenosis-related CT-MBF or QPR and the diagnostic performance of the stenosis-related CT-MBF and QPR were evaluated. Of 81 vessels, FFR was measured in 39 vessels, and 20 vessels (51%) in 15 patients were diagnosed as hemodynamically significant CAD. The stenosis-related CT-QPR showed better correlation (r= 0.70,p< 0.05) than CT-MBF (r= 0.56,p< 0.05). Sensitivity and specificity for detecting hemodynamically significant CAD were 95% and 58% for CT-MBF, and 95% and 90% for CT-QPR, respectively. The area under the receiver operating characteristic curve for the CT-QPR was significantly higher than that for the CT-MBF (0.94 vs. 0.79;p< 0.05). The stenosis-related CT-QPR derived from dynamic myocardial CTP and coronary CTA showed a better correlation with FFR and a higher diagnostic performance for detecting hemodynamically significant CAD than the stenosis-related CT-MBF.