【摘要】 目的 比较CT血流储备分数(CT-FFR)和CT心肌灌注成像(CT-MPI)对冠状动脉临界(50%～70%)狭窄特异性缺血的诊断性能。方法 前瞻性纳入14 d内行冠状动脉CT血管成像(CCTA)、CT-MPI、侵入性冠状动脉造影(ICA)和血流储备分数(FFR)检查的冠状动脉临界狭窄患者。CCTA和CT-MPI检查使用第3代双源CT机。使用机器学习CT-FFR软件测量血管临界狭窄的CTFFR。结果 最终入组35例患者共37支血管临界狭窄，其中29支血管临界狭窄的FFR≤0.8。CT-FFR与FFR具有中等程度相关性(r=0.48,P=0.001)。以FFR≤0.8为参考标准，CT-FFR和CT-MPI[相对心肌血流量(rMBF)的最佳截断值0.74]的曲线下面积(AUC)分别为0.886和0.836(P=0.699)。在血管水平，CT-FFR和CT-MPI检出冠状动脉临界狭窄特异性缺血的准确度、敏感度、特异度、阴性预测值、阳性预测值分别为89.2%、89.7%、87.5%、70.0%、96.3%和91.9%、96.6%、75.0%、85.7%、93.3%。结论 CT-FFR和CT-MPI对冠状动脉临界狭窄特异性缺血的诊断性能相当。更多还原

【Abstract】 Objective To compare the diagnostic performance of CT-derived fractional flow reserve(CT-FFR) with CT myocardial perfusion imaging(CT-MPI) for detecting intermediate coronary(50%-70%) stenosis-specific ischemia. Methods Patients with intermediate coronary stenosis who underwent coronary computed tomography angiography(CCTA),CT-MPI,invasive coronary angiography(ICA), and fractional flow reserve(FFR) within 14 days were prospectively enrolled.CCTA and CT-MPI were performed with a third generation dual-source CT.CT-FFR of intermediate vessel stenosis was measured by using machine learningbased CT-FFR software. Results A total of 37 intermediate vessel stenosis in 35 patients were finally enrolled, of which the FFR of 29 intermediate vessel stenosis was≤0.8.There was a moderate correlation between CT-FFR and FFR(r=0.48,P=0.001).With FFR≤0.8 as the reference standard,the area under the curve(AUC) of CT-FFR and CT-MPI [the optimal cut-off value of relative myocardial blood flow(r MBF) was 0.74] were 0.886 and 0.836(P=0.699),respectively.At the vascular level,the accuracy, sensitivity, specificity,negative predictive value, positive predictive value of CT-FFR and CT-MPI for detecting intermediate coronary stenosis-specific ischemia were 89.2%,89.7%,87.5%,70.0%,96.3% and 91.9%,96.6%,75.0%,85.7%,93.3%,respectively.Conclusion CT-FFR and CT-MPI demonstrate comparable diagnostic performance for detecting intermediate coronary stenosis-specific ischemia.更多还原