冠状动脉CT血流储备分数:放射科医师的观点

Coronary CT angiography derived fractional flow reserve:view from radiologist

冠心病的诊断依赖于形态学及功能学的综合评估。基于冠状动脉CT血管成像(CCTA)的血流储备分数(CT-FFR)能够从一次CCTA扫描中获得形态学及功能学信息,实现冠心病的"一站式"评估。CT-FFR是一种评估局部冠状动脉病变是否存在血流动力学改变的无创影像学检查,其适用于冠状动脉中重度狭窄或狭窄程度较轻但伴有其他高风险特征的患者,能够辅助判断病变是否引起缺血,并能够指导临床决策以及预测心血管事件风险。CT-FFR的应用需要保证良好的CCTA图像质量,需要放射科医师、临床医师以及患者的协调合作。本文从CT-FFR的测量与分析、CT-FFR的诊断价值、CT-FFR辅助临床决策及预后价值、CT-FFR与其他心血管影像功能学成像技术的比较以及未来展望方面进行阐述。

The diagnosis of coronary artery disease depends on a comprehensive assessment including morphological and functional information.Coronary CT angiography derived fractional flow reserve(CT-FFR)could obtain morphological and functional information from a single coronary CT angiography(CCTA)scan,achieving a"one-stop"assessment of coronary artery disease.CT-FFR is a non-invasive imaging examination to assess the hemodynamic changes of focal coronary lesions and suitable for patients with moderate to severe coronary artery stenosis or mild coronary artery stenosis combined with other high-risk characteristics,to assist in determining whether the lesions cause myocardial ischemia,and to guide clinical decisions and predict the risk of cardiovascular events.The application of CT-FFR relies on satisfied image quality of CCTA,and requires the cooperation of radiologists,clinicians and patients.This paper describes from the aspects of the measurement and analysis of CT-FFR,the diagnostic value of CT-FFR,the value of CT-FFR in assisting clinical decision making and prognosis,the comparison of CT-FFR with other functional cardiovascular imaging techniques and the future perspectives.