循環器ジャーナル67巻3号

2019年07月発行

特集 循環器疾患の画像診断—現状と進歩 Ⅱ．虚血性心疾患

CT Perfusionを活用する

著者： 真鍋徳子¹

所属機関： ¹北海道大学病院放射線診断科

ページ範囲：P.344 - P.348

Point
・安静時のみの撮像では冠動脈の中等度狭窄による虚血判定ができない場合がある．
・CTで包括的に冠動脈の形態的狭窄と機能的重症度評価が可能である．
・負荷Dynamic Perfusion CTによる心筋血流定量および虚血判定のノウハウについて紹介する．

参考文献

1) Uren NG, Melin JA, De Bruyne B, et al:Relation between myocardial blood flow and the severity of coronary-artery stenosis. N Engl J Med 330:1782-1788, 1994

2) Kamiya K, Sakakibara M, Asakawa N, et al:Cardiac magnetic resonance performs better in the detection of functionally significant coronary artery stenosis compared to single-photon emission computed tomography and dobutamine stress echocardiography. Circ J 78:2468-2476, 2014

3) Murthy VL, Bateman TM, Beanlands RS, et al:Clinical Quantification of Myocardial Blood Flow Using PET:Joint Position Paper of the SNMMI Cardiovascular Council and the ASNC. J Nucl Med 59:273-293, 2018

4) Tsukamoto T, Morita K, Naya M, et al:Myocardial flow reserve is influenced by both coronary artery stenosis severity and coronary risk factors in patients with suspected coronary artery disease. Eur J Nucl Med Mol Imaging 33:1150-1156, 2006

5) Daimon M, Watanabe H, Yamagishi H, et al:Physiologic assessment of coronary artery stenosis by coronary flow reserve measurements with transthoracic Doppler echocardiography:comparison with exercise thallium-201 single piston emission computed tomography. J Am Coll Cardiol 37:1310-1315, 2001

6) Naya M, Murthy VL, Blankstein R, et al:Quantitative relationship between the extent and morphology of coronary atherosclerotic plaque and downstream myocardial perfusion. J Am Coll Cardiol 58:1807-1816, 2011

7) Naya M, Tamaki N, Tsutsui H:Coronary flow reserve estimated by positron emission tomography to diagnose significant coronary artery disease and predict cardiac events. Circ J 79:15-23, 2015

8) Tomiyama Y, Manabe O, Oyama-Manabe N, et al:Quantification of myocardial blood flow with dynamic perfusion 3.0 Tesla MRI:Validation with（15）O-water PET. J Magn Reson Imaging 42:754-762, 2015

9) Klein R, Beanlands RS, deKemp RA:Quantification of myocardial blood flow and flow reserve:Technical aspects. J Nucl Cardiol 17:555-570, 2010

O PET. Eur Radiol 24:1547-1556, 2014

11) Biglands JD, Magee DR, Sourbron SP, et al:Comparison of the Diagnostic Performance of Four Quantitative Myocardial Perfusion Estimation Methods Used in Cardiac MR Imaging:CE-MARC Substudy. Radiology 275:393-402, 2015

12) Gerber BL, Belge B, Legros GJ, et al:Characterization of acute and chronic myocardial infarcts by multidetector computed tomography:comparison with contrast-enhanced magnetic resonance. Circulation 113:823-833, 2006

13) Shehata ML, Basha TA, Hayeri MR, et al:MR myocardial perfusion imaging:insights on techniques, analysis, interpretation, and findings. Radiographics 34:1636-1657, 2014

14) Obara M, Naya M, Oyama-Manabe N, et al:Diagnostic value of quantitative coronary flow reserve and myocardial blood flow estimated by dynamic 320 MDCT scanning in patients with obstructive coronary artery disease. Medicine（Baltimore）97:e11354, 2018

15) Pontone G, Baggiano A, Andreini D, et al:Stress Computed Tomography Perfusion Versus Fractional Flow Reserve CT Derived in Suspected Coronary Artery Disease:The PERFECTION Study. JACC Cardiovasc Imaging pii:S1936-878X（18）30751-4, 2018