Absolute Versus Relative Myocardial Blood Flow by Dynamic CT Myocardial Perfusion Imaging in Patients With Anatomic Coronary Artery Disease
Absolute Versus Relative Myocardial Blood Flow by Dynamic CT Myocardial Perfusion Imaging in Patients With Anatomic Coronary Artery Disease
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DOI：
10.2214/ajr.14.14087
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发表时间：
2015-07-01
影响因子：
5
通讯作者：
De Cecco, Carlo N.
中科院分区：
文献类型：
--
作者：
Wichmann, Julian L.;Meinel, Felix G.;De Cecco, Carlo N.
客观的。本研究的目的是评估用于检测显着冠状动脉狭窄的应激动态 CT 心肌灌注成像 (MPI) 得出的绝对和相对局部心肌血流 (MBF) 的诊断准确性的差异。材料和方法。对多中心登记的 137 名疑似或已知冠状动脉疾病患者（平均年龄 60.9 +/- 8.4 岁；88 名男性）的动态 CT MPI 和冠状动脉 CT 血管造影 (CTA) 数据集进行了回顾性分析。对于每个冠状动脉区域，计算绝对 MBF 和相对于远端心肌的 MBF（MBF 比率）。两名观察者一致视觉评估冠状动脉 CTA 数据集是否存在显着狭窄（>= 50% 管腔狭窄）。结果。 411 条血管中有 137 条 (33.3%) 检测到明显狭窄。在狭窄动脉供应的区域中，平均绝对 MBF 和 MBF 比率在统计上显着较低（分别为 80.7 +/- 33.7 vs 140.0 +/- 38.4 mL/100 mL/min 和 0.52 vs 0.89；均 p < 0.0001）。 ROC 分析显示，MBF 比率比绝对 MBF 具有更好的辨别力（AUC，0.925 vs 0.882；p = 0.0022），MBF 比率和绝对 MBF 截止值 0.71 或更小和 103 的敏感性（90.7% vs 82.4%；p < 0.04）和特异性（93.1% vs 80.5%；p < 0.03）更高分别为 mL/100 mL/min 或更少。结论。在应力动态 CT MPI 中，对于冠状动脉 CTA 检测到的显着冠状动脉狭窄，相对 MBF 与绝对区域 MBF 值相比提供了更高的诊断准确性。
OBJECTIVE. The purpose of this study was to evaluate differences in the diagnostic accuracy of absolute and relative territorial myocardial blood flow (MBF) derived from stress dynamic CT myocardial perfusion imaging (MPI) for the detection of significant coronary artery stenosis.MATERIALS AND METHODS. Dynamic CT MPI and coronary CT angiography (CTA) datasets from a multicenter registry of 137 patients (mean age, 60.9 +/- 8.4 years; 88 men) with suspected or known coronary artery disease were retrospectively analyzed. For each coronary territory, absolute MBF and the MBF relative to remote myocardium (MBF ratio) were calculated. Coronary CTA datasets were visually assessed for significant stenosis (>= 50% luminal narrowing) in consensus by two observers.RESULTS. Significant stenosis was detected in 137 of 411 (33.3%) vessels. Mean absolute MBF and MBF ratio were statistically significantly lower in territories supplied by arteries with stenosis (80.7 +/- 33.7 vs 140.0 +/- 38.4 mL/100 mL/min and 0.52 vs 0.89, respectively; both p < 0.0001). ROC analysis showed better discrimination by MBF ratio than by absolute MBF (AUC, 0.925 vs 0.882; p = 0.0022) and increased sensitivity (90.7% vs 82.4%; p < 0.04) and specificity (93.1% vs 80.5%; p < 0.03) for MBF ratio and absolute MBF cutoff values of 0.71 or less and 103 mL/100 mL/min or less, respectively.CONCLUSION. In stress dynamic CT MPI, relative MBF provides superior diagnostic accuracy compared with absolute territorial MBF values for coronary CTA-detected significant coronary artery stenosis.