循環器ジャーナル65巻4号

2017年10月発行

特集 ACSの診断と治療はどこまで進歩したのか Ⅱ．ACSの診断

ACSのCT，MRI診断

著者： 寺島正浩¹

所属機関： ¹医療法人社団CVIC心臓画像クリニック飯田橋

ページ範囲：P.592 - P.599

Point
・冠動脈CTによるACSの迅速診断の有用性が確立されつつある．
・心臓MRIによりACS患者の心筋虚血を正確に診断することが可能である．
・心臓MRIは心筋生存性評価，心筋梗塞サイズ，リスク領域の判定が可能である．
・冠動脈CTおよび心臓MRIによりACSの予知の試みが行われている．

参考文献

1) Hoffmann U, Truong QA, Schoenfeld DA, et al:Coronary CT Angiography versus Standard Evaluation in Acute Chest Pain. N Engl J Med 367:299-308, 2012

2) Motoyama S, Sarai M, Harigaya H, et al:Computed Tomographic Angiography Characteristics of Atherosclerotic Plaques Subsequently Resulting in Acute Coronary Syndrome. J Am Coll Cardiol 54:49-57, 2009

3) Otsuka K, Fukuda S, Tanaka A, et al:Napkin-Ring Sign on Coronary CT Angiography for the Prediction of Acute Coronary Syndrome. JACC Cardiovasc Imaging 6:448-457, 2013

4) Ko BS, Cameron JD, Munnur RK, et al:Noninvasive CT-Derived FFR Based on Structural and Fluid Analysis:A Comparison With Invasive FFR for Detection of Functionally Significant Stenosis. JACC Cardiovasc Imaging, 2016

5) Nørgaard BL, Leipsic J, Gaur S, et al:Diagnostic performance of non-invasive fractional flow reserve derived from coronary CT angiography in suspected coronary artery disease:The NXT trial. J Am Coll Cardiol 63:1145-1155, 2014

6) De Geer J, Sandstedt M, Björkholm A, et al:Software-based on-site estimation of fractional flow reserve using standard coronary CT angiography data. Acta radiol 57:1186-1192, 2016

7) Greupner J, Zimmermann E, Grohmann A, et al:Head-to-Head Comparison of Left Ventricular Function Assessment with 64-Row Computed Tomography, Biplane Left Cineventriculography, and Both 2-and 3-Dimensional Transthoracic Echocardiography. J Am Coll Cardiol 59:1897-1907, 2012

8) Greenwood JP, Maredia N, Younger JF, et al:Cardiovascular magnetic resonance and single-photon emission computed tomography for diagnosis of coronary heart disease（CE-MARC):a prospective trial. Lancet 379:453-460, 2012

9) Miller CD, Hwang W, Hoekstra JW, et al:Stress cardiac magnetic resonance imaging with observation unit care reduces cost for patients with emergent chest pain:A randomized trial. Ann Emerg Med 56:209-219, 2010

10) Miller CD, Hwang W, Case D, et al:Stress CMR imaging observation unit in the emergency department reduces 1-year medical care costs in patients with acute chest pain:A randomized study for comparison with inpatient care. JACC Cardiovasc Imaging 4:862-870, 2011

11) Miller CD, Case LD, Little WC, et al:Stress CMR reduces revascularization, hospital readmission, and recurrent cardiac testing in intermediate-risk patients with acute chest pain. JACC Cardiovasc Imaging 6:785-794, 2013

12) Judd RM, Lugo-Olivieri CH, Arai M, et al:Physiological Basis of Myocardial Contrast Enhancement in Fast Magnetic Resonance Images of 2-Day-Old Reperfused Canine Infarcts. Circulation 92:1902-1910, 1995

13) Larose E, Rodés-Cabau J, Pibarot P, et al:Predicting Late Myocardial Recovery and Outcomes in the Early Hours of ST-Segment Elevation Myocardial Infarction. J Am Coll Cardiol 55:2459-2469, 2010

14) Kim RJ, Wu E, Rafael A, et al:The Use of Contrast-Enhanced Magnetic Resonance Imaging to Identify Reversible Myocardial Dysfunction. N Engl J Med 343:1445-1453, 2000

15) Gerber BL:Accuracy of Contrast-Enhanced Magnetic Resonance Imaging in Predicting Improvement of Regional Myocardial Function in Patients After Acute Myocardial Infarction. Circulation 106:1083-1089, 2002

16) Cury RC, Shash K, Nagurney JT, et al:Cardiac magnetic resonance with T2-weighted imaging improves detection of patients with acute coronary syndrome in the emergency department. Circulation 118:837-844, 2008

17) Wagner A, Mahrholdt H, Holly TA, et al:Contrast-enhanced MRI and routine single photon emission computed tomography（SPECT）perfusion imaging for detection of subendocardial myocardial infarcts:An imaging study. Lancet 361:374-379, 2003

18) El Aidi H, Adams A, Moons KGM, et al:Cardiac Magnetic Resonance Imaging Findings and the Risk of Cardiovascular Events in Patients With Recent Myocardial Infarction or Suspected or Known Coronary Artery Disease. J Am Coll Cardiol 63:1031-1045, 2014

19) Noguchi T, Kawasaki T, Tanaka A, et al:High-intensity signals in coronary plaques on noncontrast T1-weighted magnetic resonance imaging as a novel determinant of coronary events. J Am Coll Cardiol 63:989-999, 2014