动态负荷CT心肌灌注成像诊断中重度冠心病风险患者心肌缺血的价值

目的:采用第3代双源CT进行动态负荷CT心肌灌注成像（CTP），探讨定性评估与定量评估对于中重度冠心病风险患者心肌缺血的诊断价值，并分析该项检查的临床应用有效性。方法:2016年12月至2018年4月前瞻性连续纳入北京协和医院具有稳定性心绞痛症状、临床评估为中重度冠心病风险的患者，采用第3代双源CT对入组患者进行动态负...

Stress dynamic myocardial CT perfusion in detecting myocardial ischemia for patients with intermediate to high risk of coronary artery disease: clinical analysis and practical selection

Objective The purpose of this study was to investigate the diagnostic performance of qualitative and quantitative analysis methods from dynamic myocardial CT perfusion(CTP)in identifying myocardial ischemia for intermediate-to high-coronary artery disease(CAD)risk patients,and further evaluate the clinical availability.Methods Consecutive symptomatic patients were prospectively recruited and scanned with adenosine triphosphate(ATP)-stress dynamic myocardial CTP protocol using third-generation dual-source CT.Quantitative and qualitative assessment were performed.For quantitative assessment,the segment-based absolute myocardial blood flow(MBF)values were acquired on the transmural layer of the myocardium for analysis based on the 17-segment AHA myocardial model(bulls-eye plots).The diagnostic performance of yocardial ischemia was assessed using invasive coronary angiography(ICA)and fractional flow reserve(FFR)as the reference standard.Areas under the ROC curves(AUC)and parameters were calculated and compared using DeLong test.Results Finally sixty patients underwent the CTP examination.Among these patients,there were 151 vessels underwent ICA/FFR examination for analysis in our study.According to the ICA/FFR results,58 vessels were identified as causing ischemia in 39 patients.The AUC for qualitative and quantitative assessment were 0.65(95%CI 0.58-0.73)and 0.92(95%CI 0.87-0.97),respectively.The diagnostic values of quantitative analysis was much higher than that of qualitative method(P<0.05).The effective dosage was(3.8±1.2)mSv.Conclusions The quantitative assessment of stress dynamic myocardial CTP for detecting myocardial ischemia in patients with intermediate-to high-risk of CAD was superior to qualitative evaluation.The stress dynamic myocardial CTP with the third generation dual source CT showed great clinical feasibility,which may observably reduce the effective radiation dose of the examination.