基于工作站的CT-FFR对评估冠状动脉功能性狭窄的临床初步探究  

Diagnostic performance of workstation-based CT-FFR for detection of functionally significant stenosis in coronary artery disease

作　　者：严诚 黄健峰 张利军 过伟锋 曾蒙苏 陆秀良 YAN Cheng;HUANG Jian-feng;ZHANG Li-jun;GUO Wei-feng;ZENG Meng-su;LU Xiu-liang(Departments of Radiology,Zhongshan Hospital,Fudan University,Shanghai 200032,China;Shanghai Institute of Medical Imaging,Shanghai 200032,China)

机构地区：[1]复旦大学附属中山医院放射科,上海200032 [2]上海市影像医学研究所,上海200032

出　　处：《复旦学报（医学版）》2021年第3期356-362,共7页Fudan University Journal of Medical Sciences

摘　　要：目的以负荷核素心肌灌注显像(single photon emission computedtomography/myocardial perfusion imaging,SPECT/MPI)为标准,探讨基于工作站的CT-冠状动脉血流储备分数(CT-fractional flow reserve,CTFFR)对于诊断单支冠脉病变冠脉狭窄导致心肌缺血的临床应用价值。方法将行CT冠状动脉成像(coronary CT-angiography,CCTA)检查且冠脉直径狭窄为40%~90%的单支冠脉病变患者纳入本单中心前瞻性研究。采用佳能320排螺旋CT行CCTA采集数据,扫描时间窗为70%~99%;行有创性冠状动脉造影(invasive coronary angiography,ICA)准确评估冠脉狭窄。采用基于工作站的CT-FFR软件行CT-FFR分析,以病变远端冠脉管腔直径2 mm处CT-FFR值≤0.8为具有血流动力学意义的显著狭窄。以SPECT/MPI为心肌缺血评估标准,绘制CCTA、ICA及CT-FFR的ROC曲线,获得AUC。计算3种评估方法的敏感度、特意度、阳性预测值、阴性预测值及准确度。结果共纳入41例患者(41个病变冠脉分支)。对于冠脉狭窄功能性评估的敏感度、特异度和准确度,CT-FFR分别为87.5%、96.0%和92.7%,CCTA分别为100%、32.0%和58.5%,ICA分别为93.8%、32.0%和56.1%。CT-FFR的AUC值为0.93(95%CI:0.81~0.99),显著高于CCTA的0.76(95%CI:0.60~0.88)及ICA的0.80(95%CI:0.64~0.91),差异均有统计学意义(P<0.05)。结论对于单支冠脉病变患者,以SPECT/MPI为冠脉狭窄导致心肌缺血的诊断标准,基于工作站的CT-FFR对于诊断冠脉功能性狭窄显著优于CCTA,具有良好的应用前景。Objective To investigate the diagnostic performance of workstation-based CT-fractional flow reserve(CT-FFR)for identifying functionally significant stenosis in patients with coronary artery disease(CAD)with single angiopathy,with reference to single photon emission computed tomography/myocardial perfusion imaging(SPECT/MPI).Methods Single-center prospective study underwent coronary CT angiography(CCTA)with stenosis of 40%to 90%.CCTA data was collected by Canon 320-detector CT scanner.Prospective electrocardiogram gating was used,covering 70%to 99%of the R-R interval.Invasive coronary angiography(ICA)was performed to accurately assess coronary stenosis.A workstation-based CT-FFR software version was used for CT-FFR analysis.Any lesion vessel showing a CT-FFR value≤0.80 at the site of diameter of 2.0 mm was defined as having hemodynamically significant stenosis.SPECT/MPI was used as standard for detection of stenosis-induced myocardial ischemia,ROC curve of CCTA,ICA and CT-FFR was performed to calculate the AUC.Sensitivity,specificity,positive predictive value,negative predictive value and accuracy were recorded.Results Forty-one patients(41 vessels)were included in the study.Sensitivity,specificity and accuracy of functional assessment of coronary stenosis were 87.5%,96.0%and 92.7%for CT-FFR,100%,32.0%and 58.5%for CCTA,and93.8%,32.0%and 56.1%for ICA,respectively.The AUC value of CT-FFR was 0.93(95%CI:0.81-0.99),which was significantly higher than that of CCTA(0.76,95%CI:0.60-0.88)and ICA(0.80,95%CI:0.64-0.91)(both P<0.05).Conclusion SPECT/MPI was used as the diagnostic criteria for detection of myocardial ischemia in patients with CAD with single angiopathy.The workstation-based CTFFR showed significantly better diagnostic accuracy than CCTA in the diagnosis of functional coronary stenosis,and had good applying prospect.

关 键 词：冠心病 CT冠状动脉成像(CCTA) 有创性冠状动脉造影(ICA) 血流储备分数(FFR) 

分 类 号：R445[医药卫生—影像医学与核医学]