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Direct comparison of stress- and rest-dual-energy computed tomography for detection of myocardial perfusion defect

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Abstract

We assessed the diagnostic performance of stress- and rest-dual-energy computed tomography (DECT) and their incremental value when used with coronary CT angiography (CCTA) compared with combined invasive coronary angiography (ICA)/cardiovascular magnetic resonance (CMR) for detecting hemodynamically significant stenosis causing a myocardial perfusion defect. Forty patients (30 men; mean age, 63.4 ± 8.8 years) with known or suspected coronary artery disease detected by CCTA underwent stress- and rest-DECT, CMR, and ICA. DECT iodine maps were compared with CMR on a per-segment and per-vessel basis. Diagnostic value of CCTA was assessed on a per-vessel basis before and after stress- and rest-DECT and compared to that of ICA/CMR. Compared to CMR, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of rest-DECT for detecting segment (vessel)-based perfusion defects were 29 % (46 %), 88 % (79 %), 56 % (61 %), and 70 % (67 %), respectively. Corresponding values using stress-DECT were 73 % (94 %), 83 % (74 %), 70 % (72 %), and 85 % (95 %), respectively. There was fair (κ = 0.39) agreement between rest- and stress-DECT iodine maps in identifying segments with perfusion defects. Compared with the ICA/CMR for identifying hemodynamically significant stenoses, per-vessel territory sensitivity, specificity, PPV, and NPV of CCTA were 91, 56, 55, and 91 %, respectively; those using CCTA/rest-DECT were 42, 83, 59, and 70 %, respectively; and those using CCTA/stress-DECT were 87, 79, 71, and 91 %, respectively. The area under the receiver operating characteristic curve decreased from 0.74 to 0.62 (P = 0.06) using CCTA/rest-DECT but increased to 0.83 (P = 0.02) using CCTA/stress-DECT. Stress-DECT has incremental value when used with CCTA for detecting hemodynamically significant stenoses.

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Abbreviations

CAD:

Coronary artery disease

CCTA:

Coronary computed tomography angiography

CMR:

Cardiovascular magnetic resonance

DECT:

Dual-energy computed tomography

ECG:

Electrocardiography

FFR:

Fractional flow reserve

ICA:

Invasive coronary angiography

LAD:

Left anterior descending coronary artery

LCX:

Left circumflex artery

RCA:

Right coronary artery

SPECT:

Single-photon emission computed tomography

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Acknowledgments

This work was supported by Konkuk University.

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None.

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Authors and Affiliations

  1. Department of Radiology, Konkuk University Medical Center, Konkuk University School of Medicine, 4-12 Hwayang-dong, Gwangjin-gu, Seoul, 143-729, Korea

    Sung Min Ko & Jeong Hee Park

  2. Department of Cardiology, Konkuk University Medical Center, Konkuk University School of Medicine, 4-12 Hwayang-dong, Gwangjin-gu, Seoul, 143-729, Korea

    Hweung Kon Hwang

  3. Department of Thoracic Surgery, Konkuk University Medical Center, Konkuk University School of Medicine, 4-12 Hwayang-dong, Gwangjin-gu, Seoul, 143-729, Korea

    Meong Gun Song

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  1. Sung Min Ko
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Correspondence to Hweung Kon Hwang.

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Ko, S.M., Park, J.H., Hwang, H.K. et al. Direct comparison of stress- and rest-dual-energy computed tomography for detection of myocardial perfusion defect. Int J Cardiovasc Imaging 30 (Suppl 1), 41–53 (2014). https://doi.org/10.1007/s10554-014-0410-3

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  • DOI: https://doi.org/10.1007/s10554-014-0410-3

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