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首页> 外文期刊>The American Journal of Cardiology >Combined assessment of coronary anatomy and myocardial perfusion using multidetector computed tomography for the evaluation of coronary artery disease.
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Combined assessment of coronary anatomy and myocardial perfusion using multidetector computed tomography for the evaluation of coronary artery disease.

机译：使用多探测器计算机断层扫描对冠状动脉解剖和心肌灌注进行联合评估，以评估冠状动脉疾病。

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Multidetector computed tomography (MDCT) is increasingly used as an alternative to invasive coronary angiography. Although computed tomographic coronary angiography (CTCA) has been validated against invasive coronary angiography and nuclear myocardial perfusion imaging, the potential of MDCT to evaluate perfusion has not been fully explored. We sought to (1) develop a new technique for quantitative assessment of myocardial enhancement based on analysis of MDCT images acquired for CTCA, (2) identify the underlying causes of myocardial hypoenhancement detected by MDCT, and (3) determine the added diagnostic value of the MDCT perfusion index when combined with CTCA. We studied 84 patients undergoing clinical CTCA (64 patients with invasive coronary angiogram and a control group of 20 patients). MDCT perfusion index was calculated from x-ray attenuation measured in 16 myocardial segments. Hypoenhancement was automatically detected using comparisons with the normal range obtained in the control group, and its added value was determined against invasive coronary angiographic findings combined with known previous myocardial infarction. Myocardial hypoenhancement was detected in 29 of 64 patients in 47 vascular territories, of which 36 (77%) were abnormal by the reference technique. Of these 36 abnormalities, 10 (28%) were associated with previous myocardial infarction, whereas 26 (72%) corresponded to significant coronary stenosis. The addition of MDCT perfusion index to CTCA improved its diagnostic accuracy (sensitivity 0.87 to 0.96, accuracy 0.84 to 0.88, despite a decrease in specificity 0.79 to 0.68). In conclusion, myocardial hypoenhancement is a potentially valuable addition to MDCT evaluation of coronary artery disease without additional cost in radiation dose or contrast load.
机译：多探测器计算机断层扫描（MDCT）越来越多地用作有创冠状动脉造影的替代方法。尽管计算机断层扫描冠状动脉造影（CTCA）已针对侵入性冠状动脉造影和核心肌灌注成像进行了验证，但尚未全面探索MDCT评估灌注的潜力。我们力求（1）基于对CTCA采集的MDCT图像的分析开发一种定量评估心肌增强的新技术，（2）确定由MDCT检测到的心肌功能增强的根本原因，（3）确定增加的诊断价值与CTCA结合使用时的MDCT灌注指数。我们研究了84例接受临床CTCA的患者（64例有创冠状动脉造影的患者和20例对照组）。 MDCT灌注指数是根据在16个心肌节段中测得的X射线衰减计算得出的。使用与对照组中正常范围的比较自动检测出低通气，并根据侵袭性冠状动脉造影结果和已知的先前的心肌梗塞确定其增加值。在47个血管区域的64例患者中有29例检测到心肌功能增强，其中36例（77％）通过参考技术异常。在这36种异常中，有10种（28％）与先前的心肌梗死有关，而26种（72％）与严重的冠状动脉狭窄相对应。向CTCA添加MDCT灌注指数可提高其诊断准确性（尽管特异性降低0.79至0.68，灵敏度为0.87至0.96，准确度为0.84至0.88）。总之，心肌增强功能是对MDCT评估冠状动脉疾病的潜在有价值的补充，而无需增加放射剂量或造影剂负荷。

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