2018 IJC (Single stress dataset CTP accuracy)

Background: Coronary computed tomography angiography (cCTA) has limited diagnostic accuracy in patients with intermediate to high pre-test likelihood of coronary artery disease (CAD) that may have large amounts of coronary calcium. Stress computed tomography myocardial perfusion (CTP) has emerged as a valuable strategy, combining anatomical and functional assessment of CAD. Purpose of the study is to evaluate the diagnostic accuracy of combining coronary artery imaging and myocardial perfusion in a single stress dataset versus invasive coronary angiography (ICA) and invasive fractional flow reserve (FFR) as reference standard. Methods: One-hundred-thirty consecutive symptomatic patients (age: 65± 9 years; men: 70%) scheduled for clinically indicated ICA plus invasive FFR were prospectively enrolled. cCTA + CTP were simultaneously evaluated in a single stress-dataset by blinded readers and compared to ICA and invasive FFR findings. Results: CTPwas successfully performed in all patients. The most common artifacts observed in the stress dataset for coronary artery imaging were blooming effect and motion effect related. Overall evaluability of coronary arteries by using cCTA stress dataset was 93%. In a vessel and patient-based model, stress cCTA + stress CTP showed sensitivity, specificity, negative predictive value, positive predictive value and diagnostic accuracy of 93%, 94%, 97%, 85%, 94%, and 98%, 86%, 98%, 85%, 92%, respectively. The overall effective dose (ED) of stress protocol acquisition alone was 2.5±1.1 mSv. Conclusions: Simultaneous evaluation of coronary arteries andmyocardial perfusion with single stress acquisition is feasible and it has diagnostic accuracy and low ED to identify functionally significant stenosis in patients with intermediate to high risk for CAD.背景：对于冠状动脉疾病（Coronary artery disease, CAD）验前概率为中至高且合并大量冠状动脉钙化的患者，冠状动脉计算机断层血管造影（Coronary computed tomography angiography, cCTA）的诊断准确性存在局限。负荷心肌灌注计算机断层扫描（Stress computed tomography myocardial perfusion, CTP）作为兼具冠状动脉解剖与功能评估的有效手段应运而生。本研究旨在评估单次负荷数据集联合冠状动脉成像与心肌灌注的诊断准确性，并以有创冠状动脉造影（Invasive coronary angiography, ICA）及有创血流储备分数（Invasive fractional flow reserve, FFR）作为参考标准。 方法：本研究前瞻性纳入130例连续入组的有症状患者，年龄为65±9岁，男性占比70%，所有患者均符合临床指征且拟行ICA联合有创FFR检查。由盲法阅片者对单次负荷数据集的cCTA与CTP结果进行联合评估，并与ICA及有创FFR的检查结果进行对比。 结果：所有患者均顺利完成CTP检查。冠状动脉成像负荷数据集最常见的伪影为晕状伪影（blooming effect）与运动相关伪影（motion effect）。采用cCTA负荷数据集评估冠状动脉的整体可评估率为93%。在基于血管及患者的分析模型中，负荷cCTA联合负荷CTP的灵敏度、特异度、阴性预测值、阳性预测值及诊断准确率，在血管层面分别为93%、94%、97%、85%、94%，在患者层面分别为98%、86%、98%、85%、92%。单次负荷扫描方案的整体有效剂量（Effective dose, ED）为2.5±1.1 mSv。 结论：单次负荷扫描即可同时完成冠状动脉与心肌灌注评估，该方案具备良好的诊断准确性与较低的有效剂量，可用于识别冠状动脉疾病中至高风险患者的功能显著性狭窄。