| 耿文磊,高扬,赵娜,安云强,徐波,唐熠达,窦克非,慕朝伟,宋雷,胡奉环,尹栋,高立建,张静,吕滨.CT血流储备分数对心肌缺血病变的诊断效能研究[J].中国医学影像技术,2020,36(2): |
| CT血流储备分数对心肌缺血病变的诊断效能研究 |
| Diagnostic performance of CT-FFR based on hemodynamic optimization fusion model for detecting ischemia lesion |
| 投稿时间：2020-01-17 修订日期：2020-02-16 |
| DOI： |
| 中文关键词: 冠状动脉CT血管成像，冠状动脉造影，CT血流储备分数，血流储备分数 |
| 英文关键词:Coronary CT angiography, Invasive coronary angiography, Fractional flow reserve, CT-FFR |
| 基金项目:国家重点研发计划（2016YFC1300400）；中国医学科学院创新工程（No. 2016-I2M-1-011） |
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| 中文摘要: |
| 目的 以导管测量血流储备分数（Fractional flow reserve，FFR）为金标准，评价基于血流动力学优化融合模型的CT血流储备分数（CT-FFR）对心肌缺血病变（冠状动脉狭窄所致）的诊断效能。?
方法 前瞻性入选在我院行冠状动脉 CT 血管成像（Coronary Computed Tomography Angiography，CCTA），并于1周内行冠状动脉造影检查及经导管FFR测量的患者进行对照研究。在 CCTA 影像上获得病变狭窄程度，采用基于流体力学的测量软件计算CT-FFR数值。以导管测量FFR＜0.8 为心肌缺血的金标准，绘制 CT-FFR 及 CCTA 的受试者操作特征曲线（ROC），获得曲线下面积。并计算两种方法诊断心肌缺血的敏感性、特异性、阳性预测值、阴性预测值及准确性。
结果 本研究共入选127例患者（152支血管），平均年龄56.9±8.9岁。CT-FFR与导管测量的FFR有良好一致性（仅6.6%测量值在95%一致性界限之外）。CT-FFR诊断心肌缺血病变的ROC曲线下面积在患者水平（0.92和0.69，p < 0.001）和血管水平（0.93 和0.69，p < 0.001）均优于CCTA。患者水平CT-FFR＜0.8诊断心肌缺血病变的准确性、敏感性和特异性分别为85.8%、84.1%和90.6%，CCTA＞50%分别为68.5%、82.5%和54.7%。血管水平CT-FFR＜0.8诊断心肌缺血病变的准确性、敏感性、特异性为84.9%、88.0%和84.7%，CCTA＞50%分别为69.1%、80.6%和57.7%。血管水平，狭窄程度在30%-70%的病变，CT-FFR依旧有非常好的诊断效能。
结论 CT-FFR对于心肌缺血病变的诊断效能优于CCTA，准确性及特异性有明显提升，有助于临床对心肌缺血病变的筛查，但细节问题依然有待进一步研究。
关键词 冠状动脉CT血管成像，冠状动脉造影，CT血流储备分数，血流储备分数 |
| 英文摘要: |
| Objective To evaluate the diagnostic accuracy of non-invasive CT-FFR for myocardial ischemic disease (Caused by coronary artery stenosis)based on the hemodynamic optimal fusion model, using FFR as the gold standard.
Methods Coronary CT angiography (CCTA) was performed from October, 2018 to October, 2019, and invasive coronary angiography and FFR measurement were performed within 1 week. The degree of lesion diameter stenosis was obtained on CCTA images, and the measurement software based on fluid mechanics was used to calculate the value of CT-FFR. Using FFR≤0.8 as the gold standard of hemodynamic stenosis, the operating characteristic curves of subjects with CT-FFR＜0.8 and CCTA stenosis ≥50% were drawn to obtain the area under the curve. The sensitivity, specificity, accuracy, positive predictive value (PPV), negative predictive value (NPV) of the two methods were calculated.
Results A total of 127 patients (152 lesions) were enrolled, with an average age of 56.9±8.9 years. CT-FFR and FFR have a good consistency. The area under the ROC curve of CT-FFR in the diagnosis of myocardial ischemia was better than that of CCTA at patient level (0.92 vs 0.69, p < 0.001) and vascular level (0.93 vs 0.69, p < 0.001). Per-patient accuracy sensitivity and specificity to identify myocardial ischemia were 85.8%,84.1% and 90.6% for CT-FFR＜0.8 versus 68.5%,82.5% and 54.7% for coronary CTA＞50%. Per-vessel accuracy sensitivity and specificity to identify myocardial ischemia were 84.9%,88.0% and 84.7% for CT-FFR＜0.8 versus 69.1%,80.6% and 57.7% for coronary CTA＞50%. When the degree of vascular stenosis is 30%-70%, CT-FFR still has a very good diagnostic efficacy.
Conclusion The accuracy and specificity of CT-FFR in the diagnosis of myocardial ischemia is better than that of CCTA, and it is helpful for clinical screening of myocardial ischemic lesions, but the details still need to be further studied.
Key words Coronary CT angiography, Invasive coronary angiography, Fractional flow reserve, CT-FFR |
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