- 作者：Fabian Bamberg ; MD ; MPH&lowast ; ; &dagger ; ; fbamberg@med.lmu.de" class="auth_mail ; Roy P. Marcus ; BS&lowast ; ; Alexander Becker ; MD&Dagger ; ; Kristof Hildebrandt ; BS&lowast ; ; Kerstin Bauner ; MD&lowast ; ; Florian Schwarz ; MD&lowast ; ; &dagger ; ; Martin Greif ; MD&Dagger ; ; Franz von Ziegler ; MD&Dagger ; ; Bernhard Bischoff ; MD&lowast ; ; Hans-Christoph Becker ; MD&lowast ; ; &dagger ; ; Thorsten R. Johnson ; MD&lowast ; ; Maximilian F. Reiser ; MD&lowast ; ; &dagger ; ; Konstantin Nikolaou ; MD&lowast ; ; &dagger ; ; Daniel Theisen ; MD&lowast ; ; &dagger ;
- 关键词：cardiac CT ; cardiac MR ; infarct ; ischemia ; myocardial perfusion
- 刊名：JACC: Cardiovascular Imaging
- 出版年：March, 2014
- 年：2014
- 卷：7
- 期：3
- 页码：267-277
- 全文大小：606 K
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 卤 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聽= 56 and 12.6%, n聽= 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 卤 18.7 ml/100 ml/min vs. 73.1 卤 31.9 ml/100 ml/min, respectively, p聽> 0.05), eMBV was significantly lower in infarcted segments compared with ischemic segments (11.3 卤 3.3 ml/100 ml vs. 18.4 卤 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.