Dynamic Myocardial CT Perfusion Imaging for Evaluation of Myocardial Ischemia as Determined by MR Imaging
Dynamic Myocardial CT Perfusion Imaging for Evaluation of Myocardial Ischemia as Determined by MR Imaging
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DOI：
10.1016/j.jcmg.2013.06.008
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发表时间：
2014-03-01
影响因子：
14
通讯作者：
Theisen, Daniel
中科院分区：
文献类型：
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作者：
Bamberg, Fabian;Marcus, Roy P.;Theisen, Daniel
目的 本研究的目的是确定与心脏磁共振 (CMR) 相比，基于计算机断层扫描 (CT) 的动态心肌灌注成像用于评估心肌缺血和梗死的可行性。 背景 序贯心肌 CT 灌注成像已成为一种用于评估心肌灌注不足的新型成像技术。 方法 我们前瞻性地招募患有已知冠状动脉疾病的受试者，这些受试者接受了腺苷介导的应激动态双源 CT（100 kV、 320 mAs/rot) 和 CMR (3-T)。使用基于模型的参数反卷积技术从 CT 图像中得出估计心肌血流量 (eMBF) 和估计心肌血容量 (eMBV)。这些值与在休息/应激和晚期钆增强 CMR 期间目视评估的灌注缺陷（缺血和/或梗塞心肌段）独立相关。确定了诊断准确性和 eMBF/eMBV 差异的常规测量方法。 结果 在 38 名入组受试者中，31 名（平均年龄 70.4 +/- 9.3 岁；77% 男性）完成了 CT 和 CMR 方案。 CMR 检测到的缺血和梗死心肌节段的患病率中等（484 个分析节段中，分别为 11.6%，n = 56 和 12.6%，n = 61，其中 8.4% 为透壁心肌节段）。 CT 检测任何灌注缺陷的诊断准确性良好（eMBF 阈值，88 ml/mg/min；敏感性，77.8% [95% 置信区间 (CI)：69% 至 85%]；阴性预测值，91.3% [95% CI：86% 至 94%]），阳性预测值中等（50.6% [95% CI：43% 至 58%]）和特异性（75.41% [95% CI：70% 至 79%]）。虽然高质量检查中的 eMBF 较低，但缺血性和梗死性病变之间没有差异（敏感性 87.8%；95% CI：74% 至 96%）。梗塞节段（分别为 72.3 +/- 18.7 ml/100 ml/min vs. 73.1 +/- 31.9 ml/100 ml/min，p > 0.05），与缺血节段相比，梗塞节段的 eMBV 显着较低（分别为 11.3 +/- 3.3 ml/100 ml vs. 18.4 +/- 2.8 ml/100 ml；p < 0.01). 结论 与 CMR 相比，动态应力 CT 为检测心肌灌注缺陷提供了良好的诊断准确性，并且可以区分缺血性和梗塞性心肌 (C) 2014，美国心脏病学会基金会。
OBJECTIVES The aim of this study was to determine the feasibility of computed tomography (CT)-based dynamic myocardial perfusion imaging for the assessment of myocardial ischemia and infarction compared with cardiac magnetic resonance (CMR).BACKGROUND Sequential myocardial CT perfusion imaging has emerged as a novel imaging technique for the assessment of myocardial hypoperfusion.METHODS We prospectively enrolled subjects with known coronary artery disease who underwent adenosine-mediated stress dynamic dual-source CT (100 kV, 320 mAs/rot) and CMR (3-T). Estimated myocardial blood flow (eMBF) and estimated myocardial blood volume (eMBV) were derived from CT images, using a model-based parametric deconvolution technique. The values were independently related to perfusion defects (ischemic and/or infarcted myocardial segments) as visually assessed during rest/stress and late gadolinium enhancement CMR. Conventional measures of diagnostic accuracy and differences in eMBF/eMBV were determined.RESULTS Of 38 enrolled subjects, 31 (mean age 70.4 +/- 9.3 years; 77% men) completed both CT and CMR protocols. The prevalence of ischemic and infarcted myocardial segments detected by CMR was moderate (11.6%, n = 56 and 12.6%, n = 61, respectively, of 484 analyzed segments, with 8.4% being transmural). The diagnostic accuracy of CT for the detection of any perfusion defect was good (eMBF threshold, 88 ml/mg/min; sensitivity, 77.8% [95% confidence interval (CI): 69% to 85%]; negative predictive value, 91.3% [95% CI: 86% to 94%]) with moderate positive predictive value (50.6% [95% CI: 43% to 58%] and specificity (75.41% [95% CI: 70% to 79%]). Higher diagnostic accuracy was observed for transmural perfusion defects (sensitivity 87.8%; 95% CI: 74% to 96%) and infarcted segments (sensitivity 85.3%; 95% CI: 74% to 93%). Although eMBF in high-quality examinations was lower but not different between ischemic and infarcted segments (72.3 +/- 18.7 ml/100 ml/min vs. 73.1 +/- 31.9 ml/100 ml/min, respectively, p > 0.05), eMBV was significantly lower in infarcted segments compared with ischemic segments (11.3 +/- 3.3 ml/100 ml vs. 18.4 +/- 2.8 ml/100 ml, respectively; p < 0.01).CONCLUSIONS Compared with CMR, dynamic stress CT provides good diagnostic accuracy for the detection of myocardial perfusion defects and may differentiate ischemic and infarcted myocardium. (C) 2014 by the American College of Cardiology Foundation