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首页> 美国卫生研究院文献>Frontiers in Physiology >Cardiac magnetic resonance and computed tomography angiography for clinical imaging of stable coronary artery disease. Diagnostic classification and risk stratification
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Cardiac magnetic resonance and computed tomography angiography for clinical imaging of stable coronary artery disease. Diagnostic classification and risk stratification

机译：心脏磁共振和计算机断层扫描血管造影用于稳定冠状动脉疾病的临床成像。诊断分类和风险分层

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Despite advances in the pharmacologic and interventional treatment of coronary artery disease (CAD), atherosclerosis remains the leading cause of death in Western societies. X-ray coronary angiography has been the modality of choice for diagnosing the presence and extent of CAD. However, this technique is invasive and provides limited information on the composition of atherosclerotic plaque. Coronary computed tomography angiography (CCTA) and cardiac magnetic resonance (CMR) have emerged as promising non-invasive techniques for the clinical imaging of CAD. Hereby, CCTA allows for visualization of coronary calcification, lumen narrowing and atherosclerotic plaque composition. In this regard, data from the CONFIRM Registry recently demonstrated that both atherosclerotic plaque burden and lumen narrowing exhibit incremental value for the prediction of future cardiac events. However, due to technical limitations with CCTA, resulting in false positive or negative results in the presence of severe calcification or motion artifacts, this technique cannot entirely replace invasive angiography at the present time. CMR on the other hand, provides accurate assessment of the myocardial function due to its high spatial and temporal resolution and intrinsic blood-to-tissue contrast. Hereby, regional wall motion and perfusion abnormalities, during dobutamine or vasodilator stress, precede the development of ST-segment depression and anginal symptoms enabling the detection of functionally significant CAD. While CT generally offers better spatial resolution, the versatility of CMR can provide information on myocardial function, perfusion, and viability, all without ionizing radiation for the patients. Technical developments with these 2 non-invasive imaging tools and their current implementation in the clinical imaging of CAD will be presented and discussed herein.
机译：尽管在冠状动脉疾病（CAD）的药物和介入治疗方面取得了进步，但动脉粥样硬化仍然是西方社会死亡的主要原因。 X射线冠状动脉造影已成为诊断CAD的存在和程度的一种选择。然而，该技术是侵入性的，并且提供关于动脉粥样硬化斑块组成的有限信息。冠状动脉计算机断层造影血管造影（CCTA）和心脏磁共振（CMR）已经成为有前途的CAD临床成像非侵入性技术。因此，CCTA可以使冠状动脉钙化，管腔变窄和动脉粥样硬化斑块成分可视化。在这方面，CONFIRM注册中心的数据最近表明，动脉粥样硬化斑块负担和管腔变窄均显示出对预测未来心脏事件的价值。但是，由于CCTA的技术局限性，在存在严重钙化或运动伪影的情况下导致假阳性或阴性结果，因此该技术目前无法完全替代侵入性血管造影。另一方面，CMR由于其高的时空分辨率和内在的血液-组织对比度，可提供对心肌功能的准确评估。因此，在多巴酚丁胺或血管舒张压期间，局部壁运动和灌注异常先于ST段压低和心绞痛症状的发展，从而能够检测出功能上重要的CAD。尽管CT通常可以提供更好的空间分辨率，但CMR的多功能性可以提供有关心肌功能，灌注和生存力的信息，而所有这些都无需为患者提供电离辐射。本文将介绍和讨论这2种非侵入性成像工具的技术发展及其在CAD临床成像中的当前实现方式。

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