Adenosine-Induced Stress Myocardial Perfusion Imaging Using Dual-Source Cardiac Computed Tomography

被引：344

作者：

Blankstein, Ron ^{[1
,2
,3
,4
]}

Shturman, Leon D. ^{[1
,2
,3
]}

Rogers, Ian S. ^{[1
,2
,3
]}

Rocha-Filho, Jose A. ^{[1
,2
,3
]}

Okada, David R. ^{[1
,2
,3
]}

Sarwar, Ammar ^{[1
,2
,3
]}

Soni, Anand V. ^{[1
,2
,3
]}

Bezerra, Hiram ^{[1
,2
,3
,5
]}

Ghoshhajra, Brian B. ^{[1
,2
,3
]}

Petranovic, Milena ^{[1
,2
,3
]}

Loureiro, Ricardo ^{[1
,2
,3
]}

Feuchtner, Gudrun ^{[1
,2
,3
,6
]}

Gewirtz, Henry ^{[1
,2
,3
]}

Hoffmann, Udo ^{[1
,2
,3
]}

Mamuya, Wilfred S. ^{[1
,2
,3
,7
]}

Brady, Thomas J. ^{[1
,2
,3
]}

Cury, Ricardo C. ^{[1
,2
,3
,8
]}

机构：

[1] Massachusetts Gen Hosp, Dept Radiol, Cardiac MR PET CT Program, Boston, MA 02114 USA

[2] Massachusetts Gen Hosp, Div Cardiol, Boston, MA 02114 USA

[3] Harvard Univ, Sch Med, Boston, MA USA

[4] Brigham & Womens Hosp, Dept Med & Radiol, Noninvas Cardiovasc Imaging Program, Boston, MA 02115 USA

[5] Case Western Reserve Univ, Harrington McLaughlin Heart & Vasc Inst, Cleveland, OH 44106 USA

[6] Innsbruck Med Univ, Dept Radiol, Innsbruck, Austria

[7] Lown Cardiovasc Grp, Brookline, MA USA

[8] Baptist Cardiac & Vasc Inst, Cardiovasc MR & CT Program, Miami, FL USA

来源：

JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY | 2009年 / 54卷 / 12期

基金：

美国国家卫生研究院;

关键词：

infarction; ischemia; imaging; coronary disease; computed tomography; CORONARY-ARTERY-DISEASE; SYNDROME EVALUATION WISE; COMPREHENSIVE ASSESSMENT; MAGNETIC-RESONANCE; STABLE ANGINA; INFARCTION; CT; ANGIOGRAPHY; ISCHEMIA; HEART;

D O I：

10.1016/j.jacc.2009.06.014

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

Objectives This study sought to determine the feasibility of performing a comprehensive cardiac computed tomographic (CT) examination incorporating stress and rest myocardial perfusion imaging together with coronary computed tomography angiography (CTA). Background Although cardiac CT can identify coronary stenosis, very little data exist on the ability to detect stress-induced myocardial perfusion defects in humans. Methods Thirty-four patients who had a nuclear stress test and invasive angiography were included in the study. Dual-source computed tomography (DSCT) was performed as follows: 1) stress CT: contrast-enhanced scan during adenosine infusion; 2) rest CT: contrast-enhanced scan using prospective triggering; and 3) delayed scan: acquired 7 min after rest CT. Images for CTA, computed tomography perfusion (CTP), and single-photon emission computed tomography (SPECT) were each read by 2 independent blinded readers. Results The DSCT protocol was successfully completed for 33 of 34 subjects (average age 61.4 +/- 10.7 years; 82% male; body mass index 30.4 +/- 5 kg/m(2)) with an average radiation dose of 12.7 mSv. On a per-vessel basis, CTP alone had a sensitivity of 79% and a specificity of 80% for the detection of stenosis >= 50%, whereas SPECT myocardial perfusion imaging had a sensitivity of 67% and a specificity of 83%. For the detection of vessels with >= 50% stenosis with a corresponding SPECT perfusion abnormality, CTP had a sensitivity of 93% and a specificity of 74%. The CTA during adenosine infusion had a per-vessel sensitivity of 96%, specificity of 73%, and negative predictive value of 98% for the detection of stenosis > 70%. Conclusions Adenosine stress CT can identify stress-induced myocardial perfusion defects with diagnostic accuracy comparable to SPECT, with similar radiation dose and with the advantage of providing information on coronary stenosis. (J Am Coll Cardiol 2009; 54: 1072-84) (C) 2009 by the American College of Cardiology Foundation

引用

页码：1072 / 1084

页数：13

共 26 条

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