Objectives The goal of this study was to assess the diagnostic performance of coronary computed tomography angiography (CTA) alone, adenosine-stress myocardial perfusion assessed by computed tomography (CTP) alone, and coronary CTA + CTP by using a 16-cm Z-axis coverage scanner versus invasive coronary angiography (ICA) and fractional flow reserve (FFR) as the clinical standard. Background Diagnostic performance of coronary CTA for in-stent restenosis detection is still challenging. Recently, CTP showed additional diagnostic power over coronary CTA in patients with suspected coronary artery disease. However, few data are available on CTP performance in patients with previous stent implantation. Methods Consecutive stable patients with previous coronary stenting referred for ICA were enrolled. All patients underwent stress myocardial CTP and rest CTP + coronary CTA. Invasive FFR was performed during ICA when clinically indicated. The diagnostic rate and diagnostic accuracy of coronary CTA, CTP, and coronary CTA + CTP were evaluated in stent-, territory-, and patient-based analyses. Results In the 150 enrolled patients (132 men; mean age 65.1 ± 9.1 years), the CTP diagnostic rate was significantly higher than that of coronary CTA in all analyses (territory based [96.7% vs. 91.1%; p < 0.0001] and patient based [96% vs. 68%; p < 0.0001]). When ICA was used as gold standard, CTP diagnostic accuracy was significantly higher than that of coronary CTA in all analyses (territory based [92.1% vs. 85.5%, p < 0.03] and patient based [86.7% vs. 76.7%, p < 0.03]). The concordant coronary CTA + CTP assessment exhibited the highest diagnostic accuracy values versus ICA (95.8% in the territory-based analysis). The diagnostic accuracy of CTP was significantly higher than that of coronary CTA (75% vs. 30.5%; p < 0.001). The radiation exposure of coronary CTA + CTP was 4.15 ± 1.5 mSv. Conclusions In patients with coronary stents, CTP significantly improved the diagnostic rate and accuracy of coronary CTA alone compared with both ICA and invasive FFR as gold standard.

中文翻译：

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疑似支架内再狭窄或CAD进展的患者的CT灌注与冠状动脉CT血管造影

目的本研究的目的是评估仅使用冠状动脉计算机断层扫描血管造影（CTA）的诊断性能，仅通过计算机断层扫描（CTP）评估的腺苷应激心肌灌注以及使用16厘米Z轴的冠状动脉CTA + CTP覆盖扫描仪与有创冠状动脉造影（ICA）和分流储备（FFR）作为临床标准。背景技术冠状动脉CTA在支架内再狭窄检测中的诊断性能仍然具有挑战性。最近，CTP在可疑冠状动脉疾病患者中显示出比冠状动脉CTA更高的诊断能力。但是，很少有关于先前支架植入患者的CTP性能的数据。方法连续入选曾接受过ICA冠状动脉支架置入术的稳定患者。所有患者均接受应激性心肌CTP，静息CTP +冠状动脉CTA。有临床指征时，在ICA期间进行了有创FFR。冠状动脉CTA，CTP和冠状动脉CTA + CTP的诊断率和诊断准确性通过支架，区域和患者的分析进行了评估。结果在所有纳入分析的150名入组患者（132名男性，平均年龄65.1±9.1岁）中，CTP诊断率均显着高于冠状动脉CTA（基于地区[96.7％vs. 91.1％; p <0.0001]和患者）基于[96％vs. 68％； p <0.0001]）。当使用ICA作为黄金标准时，在所有分析中，CTP的诊断准确性均显着高于冠状动脉CTA（基于区域的[92.1％比85.5％，p <0.03]和基于患者的[86.7％比76.7％，p <0.03] 0.03]）。与ICA相比，一致的冠状动脉CTA + CTP评估显示出最高的诊断准确性值（在基于区域的分析中为95.8％）。CTP的诊断准确性显着高于冠状动脉CTA（75％比30.5％； p <0.001）。冠状动脉CTA + CTP的辐射暴露为4.15±1.5 mSv。结论与ICA和有创FFR相比，CTP显着提高了单独使用冠状动脉CTA的诊断率和准确性，这是金标准。