Diagnostic performance of the quantification of myocardium at risk from MPI SPECT/CTA 2G fusion for detecting obstructive coronary disease: A multicenter trial
Diagnostic performance of the quantification of myocardium at risk from MPI SPECT/CTA 2G fusion for detecting obstructive coronary disease: A multicenter trial
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DOI：
10.1007/s12350-017-0819-x
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发表时间：
2018-08-01
影响因子：
2.4
通讯作者：
Garcia, Ernest, V
中科院分区：
文献类型：
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作者：
Piccinelli, Marina;Santana, Cesar;Garcia, Ernest, V
背景资料。冠状动脉疾病(CAD)的有效非侵入性识别及其正确的介入治疗仍是尚未解决的问题。我们评估了我们的第二代3D MPI/CTA融合框架对危险心肌(MAR)的量化，以检测和定位阻塞性冠状动脉疾病。对来自3个不同机构的48名接受静息/应激MPI、CTA和ICA的患者的研究进行了分析。从CTA中提取具有叠加冠脉的心肌的三维双室表面，并将其融合到灌注分布中。从CTA读数中识别出显著的病变，并将其定位在融合显示器上。在3D LV表面上基于MPI(MAR(P))、单独CTA(MAI(A))和融合信息(MAR(F))计算MAR的三个估计值。以ICA解剖结果为参考标准，利用危险区域范围生成ROC曲线。用MAR(F)检测冠心病的ROC曲线下面积(AUC)为0.88(CI=0.75~0.95)，以<70%狭窄为标准，MAR(P)和MAR(A)的ROC曲线下面积分别为0.82(CI=0.69~0.92)和0.75(CI=0.60~0.86)。使用MAR(F)进行CAD定位(所有血管)的AUC显示的性能明显高于MAR(A)或MAR(P)或两者。以ICA为参考标准，MAR为定量参数，AUC为评价指标，MPI-CTA融合成像为冠心病的诊断和定位提供了比单纯MPI或CTA更多的诊断信息。
Background. The effective non-invasive identification of coronary artery disease (CAD) and its proper referral for invasive treatment are still unresolved issues. We evaluated our quantification of myocardium at risk (MAR) from our second generation 3D MPI/CTA fusion framework for the detection and localization of obstructive coronary disease.Methods. Studies from 48 patients who had rest/stress MPI, CTA, and ICA were analyzed from 3 different institutions. From the CTA, a 3D biventricular surface of the myocardium with superimposed coronaries was extracted and fused to the perfusion distribution. Significant lesions were identified from CTA readings and positioned on the fused display. Three estimates of MAR were computed on the 3D LV surface on the basis of the MPI alone (MAR(p)), the CTA alone (MAI(a)), and the fused information (MAR(f) ). The extents of areas at risk were used to generate ROC curves using ICA anatomical findings as reference standard.Results. Areas under the ROC curve (AUC) for CAD detection using MAR(f) was 0.88 (CI = 0.75-0.95) and for MAR(p) and MAR( )(a)were, respectively 0.82 (CI = 0.69-0.92) and 0.75 (CI = 0.60-0.86) using the >= 70% stenosis criterion. AUCs for CAD localization (all vessels) using MAR(f) showed significantly higher performance than either MAR(a) or MAR(p) or both.Conclusions. Using ICA as the reference standard, MAR as the quantitative parameter, and AUC to measure diagnostic performance, MPI-CTA fusion imaging provided incremental diagnostic information compared to MPI or CTA alone for the diagnosis and localization of CAD.