Background The detection of in-stent restenosis (ISR) with coronary CT angiography (CCTA) is challenging, but CT perfusion (CTP) has demonstrated improved diagnostic accuracy over CCTA in patients with stents. However, there are limited data on the performance of dynamic CTP, which allows noninvasive adjudication of regional myocardial blood flow. Purpose To compare the diagnostic performance of regadenoson-stress dynamic CTP with that of CCTA, using fractional flow reserve (FFR) and the index of microvascular resistance (IMR) as reference standards for epicardial coronary circulation and coronary microcirculation, respectively. Materials and Methods Between January 2021 and June 2022, this prospective study enrolled patients with stents with indication for invasive coronary angiography due to suspicion of ISR or coronary artery disease progression. Participants underwent dynamic stress myocardial CTP and rest CTP plus CCTA. A wide coverage (z-axis coverage, 16 cm) and fast (gantry rotation time, 0.28 second) scanner was used. During invasive coronary angiography, FFR and IMR were obtained. The diagnostic rate (number of interpretable territories divided by number of evaluated territories) and accuracy of CCTA and CTP were evaluated in a territory-based analysis and compared with FFR and IMR (primary end points of the study). Results The study included 156 consecutive patients (136 men [87%]; mean age, 63.1 years ± 8.2 [SD]) with 504 stents. The diagnostic rate was higher for CTP than for CCTA (98.7% [789 of 799 territories] vs 95.6% [764 of 799 territories], P < .001). With use of FFR as the reference standard, sensitivity, specificity, and diagnostic accuracy were higher for CTP than for CCTA (89.0%, 82.8%, and 84.7%, respectively, vs 60.0%, 61.9%, and 61.5%; P < .001). With use of IMR as the reference standard, sensitivity, specificity, and diagnostic accuracy were higher with CTP than with CCTA (76.5%, 85.9%, and 82.9%, respectively, vs 48.2%, 63.5%, and 59.3%; P < .01). The mean effective dose of stress CTP plus CCTA was 10.4 mSv ± 2.7. Conclusion In patients with coronary stents, dynamic CTP improves the diagnostic performance of CCTA in the detection of territory-based ischemia. © RSNA, 2024 Supplemental material is available for this article. See also the editorial by Williams in this issue.

中文翻译：

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支架患者动态应力心肌 CT 灌注与侵入性生理学的诊断准确性：Advantage 2 研究。


背景 用冠状动脉 CT 血管造影 （CCTA） 检测支架内再狭窄 （ISR） 具有挑战性，但 CT 灌注 （CTP） 已证明支架患者诊断准确性高于 CCTA。然而，关于动态 CTP 性能的数据有限，动态 CTP 允许对区域心肌血流进行无创判断。目的 分别使用血流储备分数 （FFR） 和微血管阻力指数 （IMR） 作为心外膜冠状动脉循环和冠状动脉微循环的参考标准，比较 regadenoson 应激动态 CTP 与 CCTA 的诊断性能。材料和方法 2021 年 1 月至 2022 年 6 月期间，这项前瞻性研究招募了因怀疑 ISR 或冠状动脉疾病进展而需要进行有创冠状动脉造影的支架患者。参与者接受了动态应激心肌 CTP 和静息 CTP 加 CCTA。使用了宽覆盖范围（z 轴覆盖率，16 cm）和快速（机架旋转时间，0.28 秒）扫描仪。在有创冠状动脉造影期间，获得 FFR 和 IMR。在基于地区的分析中评估了 CCTA 和 CTP 的诊断率 （可解释区域的数量除以评估区域的数量） 和准确性，并与 FFR 和 IMR （研究的主要终点） 进行比较。结果 该研究包括 156 例连续患者 （136 名男性 [87%];平均年龄 63.1 岁 ± 8.2 [SD]），共 504 个支架。CTP 的诊断率高于 CCTA （98.7% [799 个区域中的 789 个] vs 95.6% [799 个区域中的 764 个]，P < .001）。使用 FFR 作为参考标准，CTP 的敏感性、特异性和诊断准确性高于 CCTA （分别为 89.0% 、 82.8% 和 84.7%，分别为 60.0% 、 61.9% 和 61.5%;P < .001）. 使用 IMR 作为参考标准，CTP 的敏感性、特异性和诊断准确性高于 CCTA （分别为 76.5% 、 85.9% 和 82.9%，对 48.2% 、 63.5% 和 59.3%;P < .01）.应激 CTP 加 CCTA 的平均有效剂量为 10.4 mSv ± 2.7。结论 在冠状动脉支架患者中，动态 CTP 提高了 CCTA 在区域性缺血检测中的诊断性能。© RSNA，2024 年本文提供补充材料。另请参见 Williams 在本期的社论。