Adenosine-Stress Dynamic Myocardial Perfusion Imaging With Second-Generation Dual-Source CT: Comparison With Conventional Catheter Coronary Angiography and SPECT Nuclear Myocardial Perfusion Imaging
Adenosine-Stress Dynamic Myocardial Perfusion Imaging With Second-Generation Dual-Source CT: Comparison With Conventional Catheter Coronary Angiography and SPECT Nuclear Myocardial Perfusion Imaging
复制标题
第二代双源CT腺苷应力动态心肌灌注成像：与传统导管冠状动脉造影和SPECT核心肌灌注成像的比较
DOI：
10.2214/ajr.11.7830
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发表时间：
2012-03-01
影响因子：
5
通讯作者：
Jin, Zhengyu
中科院分区：
文献类型：
--
作者：
Wang, Yining;Qin, Ling;Jin, Zhengyu
OBJECTIVE.本文的目的是评价腺苷负荷动态心肌灌注成像（MPI）与128-MDCT双源CT检测心肌缺血的可行性与传统的导管冠状动脉造影和核MPI相比。30例患者（21例男性和9例女性;平均[+/- SD]年龄，59.2 +/- 7.6岁）前瞻性接受了联合负荷CT灌注和CT血管造影（CTA）检查。完整的时间衰减曲线的心肌采集与前瞻性心电触发轴向图像在两个交替的位置。根据动态CT灌注定量心肌血流量（MBF），比较正常和异常节段的MBF值。将CT灌注结果与负荷和静息SPECT结果进行比较。CT显示的灌注缺陷与CTA和导管冠状动脉造影检测到的血流阻塞性狭窄相关。在负荷CT灌注中，19名患者（63%）和504个节段中的83个（16%）有灌注异常。正常节段（142.9 +/- 30.6 mL/100 mL/min）和低灌注节段（90.0 +/- 22.8 mL/100 mL/min）之间的MBF值存在显著差异（p < 0.001）。与核MPI结果相比，CT灌注识别灌注缺损节段的敏感性、特异性、阳性预测值和阴性预测值分别为0.85、0.92、0.55和0.98。以每支血管为基础，CT灌注检测血流阻塞性狭窄的敏感性、特异性、阳性预测值和阴性预测值分别为1.00、0.757、0.541和1.00，CTA为0.90、0.514、0.346和0.947; CT灌注联合CTA分别为0.90、0.814、0.581和0.966。腺苷负荷CT灌注检测心肌灌注缺损与核MPI具有良好的相关性。与单独CTA相比，CT灌注联合CTA提高了识别血流阻塞性狭窄的诊断准确性。
OBJECTIVE. The purpose of this article is to evaluate the feasibility of adenosine-stress dynamic myocardial perfusion imaging (MPI) with 128-MDCT dual-source CT for detecting myocardial ischemia in comparison with conventional catheter coronary angiography and nuclear MPI.SUBJECTS AND METHODS. Thirty patients (21 men and nine women; mean [+/- SD] age, 59.2 +/- 7.6 years) prospectively underwent a combined stress CT perfusion and CT angiography (CTA) examination. Complete time-attenuation curves of the myocardium were acquired with prospectively ECG-triggered axial images at two alternating positions. Myocardial blood flow (MBF) was quantified according to dynamic CT perfusion, and MBF values of normal and abnormal segments were compared. Findings on CT perfusion were compared with those for stress and rest SPECT. Perfusion defects according to CT were correlated to flow-obstructing stenosis detected on CTA and catheter coronary angiography.RESULTS. On stress CT perfusion, 19 patients (63%) and 83 of 504 segments (16%) had perfusion abnormalities. There was a significant difference in MBF values between normal (142.9 +/- 30.6 mL/100 mL/min) and hypoperfused (90.0 +/- 22.8 mL/100 mL/min) segments (p < 0.001). With nuclear MPI results as a comparison, the sensitivity, specificity, positive predictive value, and negative predictive value of CT perfusion for identifying segments with perfusion defects were 0.85, 0.92, 0.55, and 0.98, respectively. On a per-vessel basis, sensitivity, specificity, positive predictive value, and negative predictive value for detecting flow-obstructing stenosis were, respectively, 1.00, 0.757, 0.541, and 1.00 for CT perfusion; 0.90, 0.514, 0.346, and 0.947 for CTA; and 0.90, 0.814, 0.581, and 0.966 for CT perfusion combined with CTA.CONCLUSION. Adenosine-stress CT perfusion detects myocardial perfusion defects in good correlation with nuclear MPI. CT perfusion combined with CTA improves the diagnostic accuracy for identifying flow-obstructing stenosis compared with CTA alone.