摘要
目的探讨冠状动脉CT血管成像(CCTA)图像质量及其相关因素对CT血流储备分数(CT-FFR)诊断效能的影响。方法该研究基于CT-FFR CHINA临床试验, 多中心前瞻性纳入疑诊冠心病患者, 并行CCTA、CT-FFR检查和经导管血流储备分数(FFR)测量。对CCTA图像质量进行主观和客观评价, 以导管FFR为参考标准, 使用χ^(2)检验和DeLong检验比较不同主观图像质量分组(无伪影组、有伪影组)、冠状动脉血管强化程度(≤400、401~500、>500 HU)、主动脉根部信噪比(SNR)(≤16.9、>16.9)、体质指数(BMI)(<25、≥25 kg/m2)和心率组(<75、≥75次/min)间CT-FFR诊断心肌缺血准确度、灵敏度、特异度、阳性预测值、阴性预测值、受试者操作特征曲线下面积(AUC)的差异。FFR与CT-FFR≤0.8认为心肌缺血。结果本研究共纳入317例患者, 共366支血管。CCTA图像所有靶血管均成功进行CT-FFR分析, 无伪影组准确度、灵敏度、特异度、阳性预测值、阴性预测值、AUC分别为90.45%、86.75%、93.10%、90.00%、90.76%、0.928, 有伪影组为83.23%、87.21%、79.01%、81.52%、85.33%、0.869, 准确度和特异度差异具有统计学意义(χ^(2)值分别为4.23、8.55, P值分别为0.040、0.003)。图像质量客观评价指标冠状动脉血管强化程度、主动脉根部SNR以及不同BMI及心率组间CT-FFR诊断心肌缺血效能的差异无统计学意义(P均>0.05)。结论 CCTA图像伪影对CT-FFR诊断心肌缺血有影响, 客观评价指标血管强化程度、SNR及影响图像质量的因素如BMI、心率对CT-FFR的诊断效能无显著影响。
Objective To explore the impact of coronary CT angiography(CCTA)image quality and related factors on the diagnostic performance of CT-derived fractional flow reserve(CT-FFR).Methods Based on the CT-FFR CHINA trial,the prospective multicenter trial enrolled patients with suspected coronary artery disease who underwent CCTA,CT-FFR and FFR measurement.The subjective and objective assessments of CCTA image were performed on a per-vessel level.The objective assessments included the enhancement degree of coronary artery,the signal-to-noise ratio(SNR)of the aortic root.We usedχ^(2) test and DeLong test to compare the diagnostic performance of CT-FFR with FFR as the reference standard in different subjective groups(non-artifact vs.artifact),enhancement degree of coronary artery groups(≤400 vs.401-500 vs.>500 HU),SNR of the aortic root groups(≤16.9 vs.>16.9),body mass index(BMI)groups(<25 kg/m2 vs.≥25 kg/m2)and heart rate groups(<75 bpm vs.≥75 bpm).FFR and CT-FFR values≤0.80 was identified as myocardial ischemia.Results The study enrolled 317 patients with 366 vessels.All target vessels in CCTA images were successfully analyzed by CT-FFR.The accuracy,sensitivity,specificity,positive predictive value,negative predictive value and AUC of the non-artifact group were 90.45%,86.75%,93.10%,90.00%,90.76%and 0.928,respectively,and those of the artifact group were 83.23%,87.21%,79.01%,81.52%,85.33%and 0.869,respectively.The differences in accuracy and specificity were statistically significant(χ^(2)=4.23,P=0.040;χ^(2)=8.55,P=0.003).The diagnostic efficacy of CT-FFR had no statistically significant differences among different objective groups(all P>0.05).Conclusions The artifact of CCTA image has an effect on CT-FFR in the diagnosis of myocardial ischemia.The degree of vascular enhancement,SNR,BMI,and heart rate have no significant effect on the diagnostic performance of CT-FFR.
作者
孟庆超
高扬
赵娜
宋雷
胡红杰
蒋涛
陈文强
张峰
李琳
徐立
李笃民
范丽娟
慕朝伟
崔锦刚
安云强
徐波
吕滨
Meng Qingchao;Gao Yang;Zhao Na;Song Lei;Hu Hongjie;Jiang Tao;Chen Wenqiang;Zhang Feng;Li Lin;Xu Li;Li Dumin;Fan Lijuan;Mu Chaowei;Cui Jingang;An Yunqiang;Xu Bo;Lyu Bin(Department of Radiology,Fuwai Hospital,National Center for Cardiovascular Diseases,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100037,China;Department of Cardiology,Fuwai Hospital,National Center for Cardiovascular Diseases,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100037,China;Department of Radiology,Sir Run Run Shaw Hospital,Zhejiang University School of Medicine,Hangzhou 310016,China;Department of Radiology,Beijing Chao-yang Hospital,Capital Medical University,Beijing 100020,China;Department of Cardiology,Qilu Hospital of Shandong University,Jinan 250012,China;Department of Cardiology,Teda International Cardiovascular Hospital,Tianjin 300457,China;Department of Cardiology,Sir Run Run Shaw Hospital,Zhejiang University School of Medicine,Hangzhou 310016,China;Heart Center,Beijing Chao-yang Hospital,Capital Medical University,Beijing 100020,China;Department of Radiology,Qilu Hospital of Shandong University,Jinan 250012,China;Department of Radiology,Teda International Cardiovascular Hospital,Tianjin 300457,China;Catheterization Laboratories,Fuwai Hospital,National Center for Cardiovascular Diseases,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100037,China)
出处
《中华放射学杂志》
CAS
CSCD
北大核心
2023年第2期150-156,共7页
Chinese Journal of Radiology
基金
中国医学科学院临床与转化医学研究项目(2019XK320065)
国家重点研发计划(2016YFC1300400)
北京市科委AI+健康协同创新培育项目(Z201100005620013)。
