Adenosine-Stress Dynamic Myocardial CT Perfusion Imaging Initial Clinical Experience
Adenosine-Stress Dynamic Myocardial CT Perfusion Imaging Initial Clinical Experience
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DOI：
10.1097/rli.0b013e3181dfa2f2
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发表时间：
2010-06-01
影响因子：
6.7
通讯作者：
Schoepf, U. Joseph
中科院分区：
文献类型：
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作者：
Bastarrika, Gorka;Ramos-Duran, Luis;Schoepf, U. Joseph
目的：比较第二代双源计算机断层扫描（CT）与应激灌注和活力磁共振成像（MRI）对腺苷-应激动态心肌容量灌注成像定性定量评价心肌血流量（MBF）的可行性。材料和方法：10例患者（男性8例，女性2例，平均年龄62.7±7.1岁）接受了应激/休息灌注和延迟增强MRI，心脏CT方案包括前瞻性心电图触发冠状动脉CT血管造影、使用“穿梭”模式的动态腺苷-应激心肌灌注成像和延迟增强获取。两名独立观察员目测心肌灌注缺损。为了进行半定量评估，比较了CT和mri衍生的心肌到左心室上倾指数。此外，基于动态灌注CT定量绝对MBF，并与半定量CT测量相关联。在节段基础上进行心肌灌注分析。分析采用配对t检验、Wilcoxon符号秩检验、线性相关和Bland-Altman统计。结果：共有149个片段（93.1%）适合分析。与MRI相比，CT检测心肌灌注缺损的敏感性、特异性、阳性预测值和阴性预测值分别为86.1%、98.2%、93.9%和95.7%。半定量分析CT数据显示，缺血和非缺血心肌的信号强度上坡与MRI值相当（CT: 5.2 +/- 2 SI/s, MRI: 4.8 +/- 2.3 SI/s, P < 0.05）。MBF的绝对CT定量与半定量CT测量之间存在中度相关性。整个心脏CT方案的平均总剂量长度积为1290.4 +/- 233.3 mGy cm。结论：腺苷负荷容积法首次通过CT灌注成像是可行的，可以像MRI一样评估心肌灌注的定性和半定量参数。
Objective: To evaluate the feasibility of adenosine-stress dynamic myocardial volume perfusion imaging with second generation dual source computed tomography (CT) for the qualitative and quantitative assessment of myocardial blood flow (MBF) compared with stress perfusion and viability magnetic resonance imaging (MRI).Material and Methods: Ten patients (8 male, 2 female, mean age 62.7 +/- 7.1 years) underwent stress/rest perfusion and delayed-enhancement MRI, and a cardiac CT protocol comprising prospectively electrocardiogram -triggered coronary CT angiography, dynamic adenosine-stress myocardial perfusion imaging using a "shuttle" mode, and delayed enhancement acquisitions. Two independent observers visually assessed myocardial perfusion defects. For semi-quantitative evaluation, CT- and MRI-derived myocardial-to-left ventricular upslope indices were compared. Additionally, absolute MBF was quantified based on dynamic perfusion CT and correlated with semi quantitative CT measurements. Myocardial perfusion analysis was performed on a segmental basis. Analysis used paired t tests, Wilcoxon signed-rank test, linear correlation, and Bland-Altman statistics.Results: A total of 149 segments (93.1%) were suitable for analysis. Sensitivity, specificity, positive and negative predictive values for detection of myocardial perfusion defects at CT compared with MRI were 86.1%, 98.2%, 93.9%, and 95.7%, respectively. Semiquantitative analysis of CT data showed significant differences between ischemic and nonischemic myocardium with a signal intensity upslope that was comparable with MRI-derived values (CT: 5.2 +/- 2 SI/s, MRI: 4.8 +/- 2.3 SI/s, P > 0.05). Moderate correlation was observed between absolute CT quantification of MBF and semi-quantitative CT measurements. Mean total dose length product for the entire cardiac CT protocol was 1290.4 +/- 233.3 mGy cm.Conclusion: Adenosine-stress volumetric first pass CT perfusion imaging is feasible and may enable the evaluation of qualitative and semi quantitative parameters of myocardial perfusion in a comparable fashion as MRI.