部分流量储备
医学
心肌灌注成像
冠状动脉疾病
狭窄
灌注
病变
放射科
冠状动脉钙评分
逻辑回归
核医学
冠状动脉钙
心脏病学
内科学
冠状动脉造影
心肌梗塞
病理
作者
Da-Zhong Xu,Zhigang Lu,Yarong Yu,Li Yu,Hao Xu,Jiayin Zhang
出处
期刊:Quantitative imaging in medicine and surgery
[AME Publishing Company]
日期:2022-02-01
卷期号:12 (2): 1257-1269
被引量:4
摘要
We aimed to optimize the diagnostic strategy for dynamic computed tomography myocardial perfusion imaging (CT-MPI) and CT fractional flow reserve (CT-FFR) in the evaluation of coronary artery disease (CAD).Patients who had undergone coronary CT angiography (CCTA) + dynamic CT-MPI and invasive coronary angiography (ICA)/FFR within a 4-week period were retrospectively included. Lesion-specific characteristics were recorded, and multivariate logistic regression was performed to determine the predictors of mismatched CT findings with ICA results. An optimized diagnostic strategy was proposed based on the diagnostic performance of dynamic CT-MPI and CT-FFR compared with ICA/FFR. A net reclassification index (NRI) was calculated to determine the incremental discriminatory power of optimized CT-FFR + dynamic CT-MPI strategy compared to CT-FFR alone.The study included 180 patients with 229 diseased vessels. For CT-FFR, a calcified lesion with a calcium arc >180° was the only independent predictor for misdiagnosis of ischemic coronary stenosis (odds ratio =2.367; P=0.002). For noncalcified lesions and calcified lesions with a calcium arc ≤180°, the sensitivity and negative predictive value (NPV) of CT-FFR were similar to those of CT-MPI (all P values >0.05), whereas the specificity and positive predictive value (PPV) of CT-FFR were significantly lower (all P values <0.05). For calcified lesions with a calcium arc >180°, the specificity, NPV, and PPV of CT-FFR were inferior to those of CT-MPI (21.2% vs. 100%, 58.3% vs. 86.8%, and 62.9% vs. 100%, respectively; all P values <0.05). As guided by lesion-specific calcium morphology, an optimized CT-FFR + dynamic CT-MPI strategy (NRI =0.2; P=0.004) would have resulted in a 27.0% and 33.9% reduction of radiation dose and contrast medium consumption, respectively, and 25.3% of patients would have avoided unnecessary invasive tests.The diagnostic performance of CT-FFR was significantly inferior in lesions with a calcium arc >180°. Lesion-specific calcium morphology is the preferred parameter to guide the appropriate use of CT-based functional assessment.
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