Diagnostic performance of combined noninvasive coronary angiography and myocardial perfusion imaging using 320-MDCT: the CT angiography and perfusion methods of the CORE320 multicenter multinational diagnostic study

OBJECTIVE: Coronary MDCT angiography has been shown to be an accurate noninvasive tool for the diagnosis of obstructive coronary artery disease (CAD). Its sensitivity and negative predictive value for diagnosing percentage of stenosis are unsurpassed compared with those of other noninvasive testing methods. However, in its current form, it provides no information regarding the physiologic impact of CAD and is a poor predictor of myocardial ischemia. CORE320 is a multicenter multinational diagnostic study with the primary objective to evaluate the diagnostic accuracy of 320-MDCT for detecting coronary artery luminal stenosis and corresponding myocardial perfusion deficits in patients with suspected CAD compared with the reference standard of conventional coronary angiography and SPECT myocardial perfusion imaging. CONCLUSION: We aim to describe the CT acquisition, reconstruction, and analysis methods of the CORE320 study.     

Quantitative measures of coronary stenosis severity by 64-Slice CT angiography and relation to physiologic significance of perfusion in nonobese patients: comparison with stress myocardial perfusion imaging.

Coronary stenosis severity by 64-slice CT angiography (CTA) is acceptably correlated with intravascular ultrasound. Stress myocardial perfusion imaging using SPECT is an established method for assessment of the functional significance of coronary stenosis. Our aim was to assess a clinical validation of quantitative measurements of coronary stenosis severity by 64-slice CTA and the relation to the physiologic significance of myocardial perfusion. METHODS: One hundred four patients with suspected coronary artery disease underwent 64-slice CTA and stress 201Tl SPECT. The stenosis severities of 105 coronary lesions assessed by CTA with sufficient image quality were compared with the results of stress 201Tl SPECT. The body mass index (BMI) of the patients was 23.8 kg/m2 (range, 21.1-25.6 kg/m2). RESULTS: Reversible defects began to increase progressively when the area of stenosis was at least 60%, and the prevalence of these reversible defects and their severity significantly increased as the degree of stenosis increased. When stenosis severity by CTA is < 60%, ischemia is seldom observed; when stenosis severity is > or =80%, ischemia is common (86%). For intermediate stenosis severity values of 60%-70%, the prevalence of reversible defects was 9 of 27 vessels (33%), and for stenosis severity values of 70%-80%, the prevalence was 20 of 37 vessels (54%). When evaluating the diagnostic accuracy of stenosis severity by CTA to identify patients with ischemia excluding all nonevaluable vessels, applying stenosis thresholds of >70% results in 79% sensitivity, 92% specificity, 66% positive predictive value, and 96% negative predictive value. A lesion minimal luminal cross-sectional area of < 3.7 mm2 was a good accurate cutoff value for significant coronary narrowing using stress SPECT, with a sensitivity of 88% and specificity of 83% by receiver-operating-characteristic analysis. CONCLUSION: Despite an excellent negative predictive value to rule out the presence of ischemia, 64-slice CTA alone is a poor discriminator of the functional significance of myocardial ischemia in a highly selected patient population with a low BMI.     

Comparison of spiral multidetector CT angiography and myocardial perfusion imaging in the noninvasive detection of functionally relevant coronary artery lesions: first clinical experiences.

Compared with conventional coronary angiography, spiral multidetector CT (MDCT) angiography has delivered promising accuracy in the detection and validation of coronary lesions. Myocardial perfusion imaging (MPI) using SPECT is an established method for noninvasively assessing the functional significance of coronary stenoses and delivers valuable information for risk stratification. This retrospective analysis compared the accuracies of MDCT angiography and MPI in the detection of hemodynamically relevant lesions of the coronary arteries. METHODS: Twenty-five patients with suspected or known coronary artery disease were studied. Electrocardiographically gated MPI and 16-MDCT angiography were performed. Myocardial perfusion images were analyzed by 2 experienced observers, and reversible and fixed perfusion defects were detected and allocated to their corresponding coronary vessels. For the evaluation of MDCT angiography, image quality was determined, and lesions > or = 50% and luminal narrowing < 50% were visually assessed and characterized by 2 independent observers unaware of the results of MPI. RESULTS: Ninety-nine coronary vessels were analyzed, and the quality of MDCT angiography images was assessed for 330 coronary segments. Coronary artery diameter was interpretable for 231 (70%) of 330 segments, whereas in 99 (30%) of 330 segments, vessel diameter could not be evaluated because of heavy calcifications, blurring, motion artifacts, or intracoronary stents. MDCT angiography detected stenoses > or = 50% in 15 of 100 coronary arteries. Eight (53%) of 15 stenoses > or = 50% showed reversible or fixed perfusion defects in the corresponding myocardial areas on MPI. Sensitivity, specificity, and negative and positive predictive values were 100%, 87%, 100%, and 29%, respectively, for the ability of MDCT angiography to detect reversible perfusion defects in the corresponding myocardial areas. CONCLUSION: MDCT angiography detected myocardial ischemia, as defined by reversible perfusion defects on MPI, with a positive predictive value of 29% in a nonselected study cohort. Compared with MPI alone, MDCT angiography added important morphologic information, but MPI remains mandatory for evaluating the functional relevance of coronary artery lesions.     

Detection of coronary artery calcifications predicting coronary heart disease: comparison of fluoroscopy and spiral CT

The aim of this study was to evaluate the clinical relevance of coronary artery calcifications detected by spiral CT, congruence with fluoroscopy (FS) and coronary angiography, and comparison with studies reporting on application of double-helical CT and ultrafast CT. Forty patients underwent spiral CT (2-mm slice thickness, table feed 3 mm/s), coronary angiography, and FS (performed in the usual manner). Stenosis and calcifications were evaluated semiquantitatively. Nineteen patients suffering from a stenosis ≥ 75 % were verified at coronary angiography. All had coronary artery calcification on spiral CT. Fluoroscopy did not detect 8 of 19 patients with a stenosis ≥ 75 % (1 vessel: n = 1; 2 vessels: n = 3; 3 vessels: n = 4). In spiral CT sensitivity was 100 % and specificity was 33 % (FS: 58 and 48 %). Positive predictive value was 83 % for spiral CT (FS: 50 %), and negative predictive value was 100 % (FS: 56 %). A significant linear increase in the calcification score was found for increasing maximal stenosis (p < 0.005). Spiral CT is more sensitive than FS in the recognition of hemodynamic relevant stenoses using the detection of coronary artery calcifications. Statistical parameters are comparable to ultrafast-CT. Spiral CT is a suitable non-invasive diagnostic technique in coronary heart disease. Coronary calcifications found incidentally in symptomatic patients at chest CT should be reported to the referring physician for further cardiological workup. Received 14 July 1997; Revision received 29 December 1997; Accepted 5 January 1998     

Clinical implication of reverse redistribution on99mTc-sestamibi images for evaluating ischemic heart disease

OBJECTIVE: The purpose of this study was to clarify the usefulness of 99mTc-sestamibi (MIBI) delayed imaging in the assessment of the severity of myocardial ischemia in patients with coronary artery stenosis. METHODS: Forty-three angina pectoris with coronary stenosis of greater than 75% were enrolled in this study. Myocardial perfusion SPECT images were obtained 1 and 6 hours after an intravenous injection of MIBI at rest. Stress myocardial perfusion SPECT images were also acquired after the injection of MIBI. And myocardial fatty acid metabolism images were obtained 30 minutes after the injection of BMIPP at rest. Myocardial perfusion SPECT images were divided into 20 segments which were semiquantitatively assessed according to a 4-level defect score scale: score 0 (normal) to score 3 (severely); then the extent score (ES) and severity score (SS) were calculated. RESULTS: The sensitivity for myocardial ischemia showed the highest rate at 88.3% with MIBI delayed SPECT. According to the coronary angiography findings, MIBI stress SPECT and MIBI delayed SPECT detected the severity and extent of ischemia with more sensitivity than MIBI early SPECT in 12 patients (group A) with stenosis of more than 75% but less than 90% (p < 0.01). Even though MIBI stress SPECT detected the severity and extent of ischemia in 31 patients (group B) with stenosis of more than 90% but less than 100%, there was no significant difference between MIBI stress SPECT and MIBI delayed SPECT. BMIPP SPECT revealed significant differences between group A and group B regarding the severity of myocardial ischemia. MIBI reverse redistribution was observed in 33 patients and no significant difference existed between groups A and B. CONCLUSIONS: Myocardial washout of MIBI was frequently observed in patients with angina pectoris and the detection accuracy for ischemia was high. MIBI imaging is considered useful for assessment not only of myocardial perfusion but also mitochondrial function. The imagings with BMIPP and delayed MIBI could serve to determine the severity of myocardial ischemia more accurately.     

静注潘生丁,锝—甲氧异丁异睛心肌灌注SPECT诊断冠心病的评价

目的:全面评价静注潘生丁99m锝—MIBI心肌单光子发射计算机断层显像术(SPECT)诊断冠心病(CAD)的临床价值.材料和方法:在51名受试者中与冠状动脉造影比较得出SPECT的敏感性、特异性、准确度、阳性预测值、阴性预测值;并将SPECT与活动平板心电图(TECG)、Holter直接比较.结果:SPECT的敏感性为83%、特异性84%、准确度84%、阳性预测值89%、阴性预测值86%;在均接受SPECT、TECG的31例中,前者较后者为优(敏感性89%与68%、特异性77%与54%、准确度84%与62%).在42名受试者中SPECT也较Holter准确(敏感性80%与48%、特异性82%与47%、准确度81%与48%).结论:SPECT心肌灌注显像是准确性较高的诊断CAD的无创伤性方法.     

64排螺旋CT对冠心病的诊断价值

目的研究64排螺旋CT冠状动脉成像对冠状动脉疾病的诊断价值。方法搜集128例可疑或已确诊为冠心病的患者进行64排螺旋CT扫描和常规冠状动脉造影,然后对2种检查方法的结果进行对比分析。结果128例患者共有1920个冠状动脉节段可用于评价,结果显示64排螺旋CT诊断冠状动脉病变的敏感性为92%,特异性为94%,阳性预测值为82%,阴性预测值为96%。结论64排螺旋CT对冠心病的诊断及病变程度的评估具有较高的准确性、特异性和敏感性。     

CT冠状动脉成像在冠心病诊断中的应用

目的:研究CT冠状动脉成像在冠心病早期诊断冠状动脉狭窄定性定量判读的作用。方法:对34例临床未发生急性冠脉综合征的冠心病患者,先后进行冠状动脉造影、128排双源CT冠状动脉成像。以冠状动脉造影为"金标准",计算CT冠状动脉成像敏感性、特异性、阳性预测值、阴性预测值。结果:①与冠状动脉造影相比,CT冠状动脉成像的敏感性为68%,特异性为97%,阳性预测值为89%,阴性预测值为90%。②CT冠状动脉成像有65个血管段图像质量差,约占12%,造成图像质量差的原因主要为钙化,心跳、呼吸伪影,少部分为管腔显示不良。结论:冠心病早期诊断中,CT冠状动脉成像可用作冠状动脉造影前筛选,CT冠状动脉成像阴性的患者不必行冠状动脉造影检查;CT冠状动脉成像阳性的患者,可行冠状动脉造影进一步确认病变。     

电子束CT检出冠状动脉钙化及其与心肌灌注显像的对比研究

目的比较电子束ＣＴ（ＥＢＣＴ）检查冠状动脉钙化（ＣＡＣ）及核素心肌灌注显像（ＭＰＩ）评价冠心病（ＣＨＤ）的价值。材料与方法本组５０例均为临床疑诊或确诊为ＣＨＤ患者。所有患者均行ＥＢＣＴ、ＭＰＩ及冠状动脉造影。结果４０例患者共８４支血管冠状动脉造影证实有明显的冠状动脉病变（ＣＡＤ）（狭窄＞５０％），其中１４例为单支病变，８例为双支病变，１８例为三支病变，另有１０例冠状动脉造影正常。ＥＢＣＴ预测ＣＡＤ的敏感性、特异性及准确性为８３％、８０％及８２％，ＭＰＩ预测ＣＡＤ的敏感性、特异性及准确性分别为８５％、８０％及８４％，ＥＢＣＴ与ＭＰＩ的结果间无显著性差异（Ｐ＞０．０５）。ＣＡＣ血管供血区出现心肌缺血者达６５％。结论ＣＡＣ是预测ＣＡＤ的有价值指标。在有症状的人群中ＥＢＣＴ检出ＣＡＣ预测ＣＡＤ的敏感性、特异性及准确性与ＭＰＩ相似。有症状人群中检出ＣＡＣ患者多有心肌缺血或梗死，因此为早期诊断冠心病，应对无症状人群进行筛选。     

Role of cardiac computed tomography in patients with suspected coronary artery disease: interaction with nuclear cardiology

Coronary computed tomography (CT) angiography (CTA) and myocardial perfusion single photon emission CT (SPECT, or MPS) provide complementary information on vascular structure and myocardial perfusion. In patients with coronary artery disease (CAD), the combination of both methods is helpful for disease detection and therapeutic strategy planning. This article addresses the utility of coronary CTA with current 64-row multidetector CT instruments, MPS, and the combination of these methods in the evaluation of CAD.     

Aortic atherosclerosis detected with electron-beam CT as a predictor of obstructive coronary artery disease

RATIONALE AND OBJECTIVES: Several studies have demonstrated an association between coronary and aortic atherosclerosis. Aortic atherosclerosis is easily quantified by means of electron-beam computed tomography (CT). The aim of this study was to evaluate the usefulness of measurement of aortic atherosclerosis with electron-beam CT as an independent predictor of obstructive coronary artery disease (CAD). MATERIALS AND METHODS: Ninety-seven patients (67 men, 30 women; mean age, 61 years +/- 12) were enrolled and underwent electron-beam CT with and without contrast material. Coronary artery calcification was quantified with nonenhanced electron-beam CT by means of Agatston score. CAD was defined as luminal narrowing of the coronary artery by at least 70%, as measured with electron-beam angiography. Aortic atherosclerosis was quantified by measuring raised lesions of the aortic wall (plaque) and wall thickening (volume and thickness) in the midportion of the descending thoracic aorta (10 contiguous sections), as depicted at contrast material-enhanced CT angiography. RESULTS: Aortic plaque and calcification were detected only in patients who were at least 58 years old. The presence of aortic plaque was predictive of obstructive CAD, independent of coronary artery calcification. The sensitivity of aortic plaque (raised lesions) for obstructive CAD was 89% in patients at least 58 years old, and the specificity was 63%. Aortic calcification had a sensitivity of 56% and a specificity of 72% for diagnosis of obstructive CAD. CONCLUSION: This study demonstrated that aortic plaque detected with contrast-enhanced electron-beam CT was a more consistent predictor of obstructive CAD than other independent aortic variables. Aortic calcification depicted on nonenhanced CT images was highly specific for obstructive CAD.     

腺苷试验与运动试验201Tl心肌灌注显像对冠心病诊断价值的比较

目的比较腺苷试验与运动试验^201Tl心肌灌注显像对冠心病的诊断价值。方法将41例临床疑诊冠心病患者随机分为两组,一组进行腺苷试验^201Tl心肌灌注显像,一组进行运动试验^201Tl心肌灌注显像。两组试验对象均同期（2周内）行冠状动脉造影术。以冠状动脉狭窄≥50%作为冠心病诊断的“金标准”,比较两种负荷方法对冠心病的诊断价值。结果腺苷试验^201Tl心肌灌注显像对冠心病诊断的灵敏度、特异度、阳性预测率、阴性预测率、准确率分别为92.86%、57.14%、81.25%、80.0%、80.95%,运动试验^201Tl心肌灌注显像分别为100%、60.0%、71.43%、100%、80.0%,两种负荷方法对病变冠状动脉的检出率分别为66.67%和72.22%。结论两种负荷方法诊断冠心病的总体效能无显著差异。     

Quantitative coronary arterial stenosis assessment by multidetector CT and invasive coronary angiography for identifying patients with myocardial perfusion abnormalities

Background

Semi-quantitative stenosis assessment by coronary CT angiography only modestly predicts stress-induced myocardial perfusion abnormalities. The performance of quantitative CT angiography (QCTA) for identifying patients with myocardial perfusion defects remains unclear.

Methods

CorE-64 is a multicenter, international study to assess the accuracy of 64-slice QCTA for detecting ??50% coronary arterial stenoses by quantitative coronary angiography (QCA). Patients referred for cardiac catheterization with suspected or known coronary artery disease were enrolled. Area under the receiver-operating-characteristic curve (AUC) was used to evaluate the diagnostic accuracy of the most severe coronary artery stenosis in a subset of 63 patients assessed by QCTA and QCA for detecting myocardial perfusion abnormalities on exercise or pharmacologic stress SPECT.

Results

Diagnostic accuracy of QCTA for identifying patients with myocardial perfusion abnormalities by SPECT revealed an AUC of 0.71, compared to 0.72 by QCA (P?=?.75). AUC did not improve after excluding studies with fixed myocardial perfusion abnormalities and total coronary arterial occlusions. Optimal stenosis threshold for QCTA was 43% yielding a sensitivity of 0.81 and specificity of 0.50, respectively, compared to 0.75 and 0.69 by QCA at a threshold of 59%. Sensitivity and specificity of QCTA to identify patients with both obstructive lesions and myocardial perfusion defects were 0.94 and 0.77, respectively.

Conclusions

Coronary artery stenosis assessment by QCTA or QCA only modestly predicts the presence and the absence of myocardial perfusion abnormalities by SPECT. Confounding variables affecting the relationship between coronary anatomy and myocardial perfusion likely account for some of the observed discrepancies between coronary angiography and SPECT results.     

The relationship between stress-induced myocardial ischemia and coronary artery atherosclerosis measured by hybrid SPECT/CT camera

Objective  

The coronary artery calcium (CAC) score and myocardial perfusion imaging can now be detected simultaneously using a hybrid SPECT/CT camera. However, there has been little evaluation on the relationship between stress-induced ischemia and coronary artery calcification in a Japanese population. The aim of this study was to investigate the relationship between these parameters and to elucidate the diagnostic value of the CAC score as an adjunct to myocardial perfusion imaging (MPI) for the assessment of coronary artery disease (CAD) in an intermediate-risk population.     

MRI detection of myocardial perfusion defects due to coronary artery stenosis with MS-325

PURPOSE: To assess the value of an intravascular, albumin-targeted contrast agent, MS-325, in visualizing myocardial ischemia with magnetic resonance imaging (MRI). MATERIALS and METHODS: Left anterior descending coronary artery (LAD) stenosis was created in 19 pigs using a closed-chest modified angioplasty technique. Myocardial ischemia was detected by first-pass, contrast-enhanced MRI at peak dipyridamole stress and was compared to Technetium-99m (Tc-99m) sestamibi single photon emission computed tomography (SPECT). Regional coronary blood flow was determined using microspheres. RESULTS: Inducible myocardial ischemia with >40% reduction in stress myocardial blood flow was created in eight animals. An MRI defect, classified as > or=75% reduction in peak myocardial signal intensity in the affected territory, was detected in 92.3% of these animals. In the presence of mild coronary stenosis, there was uniform enhancement with MRI and tracer uptake by SPECT. Concordance of MRI and SPECT for detecting perfusion defects was 85%. CONCLUSION: The pattern of prolonged and persistent MR hypoenhancement of the ischemic myocardial bed using MS-325, which is retained primarily in the vascular bed due to its albumin-binding properties, facilitates the detection of myocardial perfusion defects.     

Sixty-four slice spiral CT angiography does not predict the functional relevance of coronary artery stenoses in patients with stable angina

Purpose The aim of this study was to evaluate spiral multidetector computed tomography (MDCT) angiography using 64-slice technique in the detection of functionally relevant coronary artery stenoses (CAS). Methods Thirty-eight patients (62±11 years, 28 men) with stable angina (26 with suspected and 12 with known coronary artery disease) were investigated using 64-slice MDCT angiography and gated myocardial perfusion SPECT (gated SPECT); a subgroup of 30 patients had additional invasive coronary angiography (ICA). Stenoses with luminal narrowing of ≥50% were defined as “significant” in MDCT angiography and ICA. MDCT angiography was compared with gated SPECT and the combination of gated SPECT plus ICA with respect to the detection of functionally relevant CAS. Results The sensitivity, specificity and negative and positive predictive values of MDCT angiography in detecting reversible perfusion defects on gated SPECT were 63%, 80%, 94% and 32%, respectively, in vessel-based analysis and 71%, 62%, 72% and 60%, respectively, in patient-based analysis. If only reversible perfusion defects on gated SPECT with CAS ≥50% on ICA were considered, the sensitivity, specificity and negative and positive predictive values were, respectively, 85%, 79%, 98% and 33% for vessel-based analysis and 85%, 59%, 83% and 61% for patient-based analysis. Conclusion Sixty-four slice MDCT angiography failed to predict the functional relevance of CAS, but had a high negative predictive value in the exclusion of functionally relevant CAS in symptomatic patients. An editorial commentary on this paper is available at .     

64排螺旋CT冠脉成像在冠心病诊断中的应用

目的 评价64排螺旋CT冠状动脉(冠脉)成像(CTA)在冠心病诊断中的应用价值.方法 以选择性冠脉造影(SCA)结果为金标准,采用64排螺旋CT对68例疑诊冠心病患者的冠脉主干及主要分支272节段进行重建和分析,评价其诊断冠心病的灵敏度和特异度.结果 CTA能够清晰显示冠脉主干及其分支狭窄、钙化、开口起源异常及桥血管病变,CTA发现钙化病变52节段,SCA仅发现钙化病变35节段.CTA诊断冠脉病变的灵敏度96.33%,特异度98.16%,阳性预测值97.22%,阴性预测值97.56%.其中对左主干、左前降支病变及＞75%的病变灵敏度最高,分别达到100%和94.4%.结论 CTA对冠脉狭窄病变、桥血管、开口畸形、支架管腔均显影良好,对冠心病诊断有较高的准确性,对钙化病变诊断率优于冠脉造影,可以作为冠心病高危人群无创性筛选检查及冠脉支架术后随访手段.     

Coronary artery calcification detected with ultrafast CT as an indication of coronary artery disease.

To assess the relationship of coronary artery calcification to angiographically detectable disease, the authors evaluated 100 patients less than 60 years of age who underwent clinically indicated coronary angiography and ultrafast computed tomography (CT). The ultrafast CT technique consisted of 3-mm-thick contiguous sections and a 100-msec acquisition time. All patients with clinically significant disease at angiography (defined as at least one stenosis with a diameter narrowing of at least 50%) had some coronary artery calcification present at ultrafast CT (100% sensitivity in this population). The absence of calcification at ultrafast CT had a 100% negative predictive value for clinically significant coronary artery disease. Specificity and positive predictive value were 47% and 62%, respectively. Sensitivity and specificity of ultrafast CT in the detection of patients with angiographically detectable disease were 94% and 72%, respectively. Ultrafast CT of the heart is an anatomically based, noninvasive test with high sensitivity for the detection of coronary artery calcification. Ultrafast CT may be beneficial in the screening of selected populations for the presence of atherosclerotic coronary disease.     

16层螺旋CT冠状动脉成像的临床应用

目的:探讨16层螺旋CT冠状动脉(简称冠脉)成像在冠心病诊断中的临床价值。方法:选取50例临床诊断或可疑冠心病患者行16层螺旋CT冠状动脉造影检查(MSCTCA),先行冠脉钙化积分平扫,然后行冠脉增强扫描,选取一组质量最佳的薄层图像行冠脉三维重建,分析MSCTCA对冠状动脉狭窄性病变的显示能力,并对冠脉支架显示及通畅性进行评价。结果:冠脉钙化积分与其狭窄程度呈正相关,中度以上狭窄的冠脉钙化积分值明显高于轻度狭窄,其间有统计学显著性差异(P<0.001)。MSCTCA对诊断有临床意义的冠脉中度以上狭窄的敏感度、特异度、诊断准确率、阳性预测值、阴性预测值分别约89.6%、93.9%、92.6%、86.7%、95.4%。MSCTCA对冠脉支架显示良好,检出5例9根支架,其中2根支架不通畅,出现支架内再狭窄。结论:16层螺旋CT冠脉成像安全、无创,对评价冠状动脉狭窄、支架开放及通畅性等方面有着较高的临床应用价值,可作为冠心病筛查的有效手段以及介入和手术治疗后的随访手段。     

双能量CT冠状动脉成像结合CT心肌灌注诊断冠心病准确性的初步研究

目的 探讨心脏双能量CT冠状动脉造影(DE-CTA)结合CT心肌灌注(DE-CTP)对冠心病诊断的准确性.方法 对31例临床可疑或已知冠心病的患者行心脏双能量CT和负荷-静息SPECT检查,所有患者在1个月内接受导管造影检查.重建冠状动脉DE-CTA和DE-CTP图像用于冠状动脉狭窄程度和心肌灌注缺损的评判,并以冠状动脉造影为参考标准,建立DECT对冠状动脉狭窄诊断价值的基线值,进而计算DE-CTA加DE-CTP对冠心病诊断的敏感性、特异性、阳性预测值、阴性预测值和准确性.结果 28例患者获得满意的图像质量,以冠状动脉造影为参考标准:(1)DE-CTA显示112支冠状动脉,其中41支冠状动脉狭窄≥50%,诊断冠状动脉狭窄的敏感性、特异性、阳性预测值、阴性预测值分别为81%(38/47)、95%(62/65)、93%(38/41)、87%(62/71),准确性为89%(100/112);(2)DE-CTP显示46支狭窄冠状动脉供血区域心肌灌注缺损,诊断狭窄≥50%冠状动脉的敏感性、特异性、阳性预测值、阴性预测值分别为76%(36/47)、85%(55/65)、78%(36/46)、83%(55/66),准确性为81%(91/112);(4)DE-CTA加DE-CTP诊断52支冠状动脉狭窄≥50%,诊断冠状动脉狭窄的敏感性、特异性、阳性预测值、阴性预测值分别为96%(45/47)、89%(58/65)、86%(45/52)、97%(58/60),准确性为92%(103/112).结论 DE-CT一次扫描即能获得冠状动脉解剖学和血流灌注信息,可以对冠心病做出综合性诊断.DE-CTP能够为CTA提供有益的补充.

Abstract：

Objective To evaluate the combination of dual-energy CT angiography (DE-CTA) and dual-energy CT peffusion (DE-CTP) in the diagnosis of coronary artery disease. Methods Thirty-one patients with angina pectoris were examined using dual-source dual energy CT and conventional coronary angiography. For DE-CTA, we used a contrast-enhanced ECG-gated coronary scan protocol with energy levels of two tube detector arrays at 140 and 100 kVp. Two kinds of acquired images were fused for the CT angiogram and further calculated to construct a perfusion map (Siemens DE Heart PBV). The compared the following results: DE-CTA vs. CA, DE-CTP vs. CA to assess the sensitivity and specificity, and further compared DE-CTA plus DE-CTP with CA. Results DECT obtained diagnostic image quality in 28 patients.DE-CTA detected 41/112 arterial stenosis. Using CA as a reference, the sensitivity of DE-CTA was 81%(38/47), specificity was 95% (62/65), positive predictive value was 92% (38/41), negative predictive value was 87% (62/71), and accuracy was 89% (100/112). DE-CTP detected 46 perfusion defects in artery territories. Using CA as a reference, the sensitivity of DE-CTP was 76% ( 36/47), specificity was 85% (55/65), positive predictive value was 78% (36/46), negative predictive value was 83% (55/66),and accuracy was 81% (91/112). DE-CTA plus DE-CTP diagnosed 52 arteries stenosis. Using CA as a reference, combination of DE-CTA and DE-CTP gave sensitivity of 95% ( 45/47 ), specificity of 89%(58/65) , NPV of 97% (58/60), and accuracy of 92% (103/112). Conclusions DECT can provide perfusion blood volume information as well as vessel pathology in one scan. DECT can provide comprehensive diagnosis and improve diagnosis of CAD.