Automated quantitative coronary computed tomography correlates of myocardial ischaemia on gated myocardial perfusion SPECT

  • Michiel A. de Graaf
  • Heba M. El-Naggar
  • Mark J. Boogers
  • Caroline E. Veltman
  • Alexander Broersen
  • Pieter H. Kitslaar
  • Jouke Dijkstra
  • Lucia J. Kroft
  • Imad Al Younis
  • Johan H. Reiber
  • Jeroen J. Bax
  • Victoria Delgado
  • Arthur J. ScholteEmail author
Original Article



Automated software tools have permitted more comprehensive, robust and reproducible quantification of coronary stenosis, plaque burden and plaque location of coronary computed tomography angiography (CTA) data. The association between these quantitative CTA (QCT) parameters and the presence of myocardial ischaemia has not been explored. The aim of the present investigation was to evaluate the association between QCT parameters of coronary artery lesions and the presence of myocardial ischaemia on gated myocardial perfusion single-photon emission CT (SPECT).


Included in the study were 40 patients (mean age 58.2 ± 10.9 years, 27 men) with known or suspected coronary artery disease (CAD) who had undergone multidetector row CTA and gated myocardial perfusion SPECT within 6 months. From the CTA datasets, vessel-based and lesion-based visual analyses were performed. Consecutively, lesion-based QCT was performed to assess plaque length, plaque burden, percentage lumen area stenosis and remodelling index. Subsequently, the presence of myocardial ischaemia was assessed using the summed difference score (SDS ≥2) on gated myocardial perfusion SPECT.


Myocardial ischaemia was seen in 25 patients (62.5 %) in 37 vascular territories. Quantitatively assessed significant stenosis and quantitatively assessed lesion length were independently associated with myocardial ischaemia (OR 7.72, 95 % CI 2.41–24.7, p < 0.001, and OR 1.07, 95 % CI 1.00–1.45, p = 0.032, respectively) after correcting for clinical variables and visually assessed significant stenosis. The addition of quantitatively assessed significant stenosis (χ 2 = 20.7) and lesion length (χ 2 = 26.0) to the clinical variables and the visual assessment (χ 2 = 5.9) had incremental value in the association with myocardial ischaemia.


Coronary lesion length and quantitatively assessed significant stenosis were independently associated with myocardial ischaemia. Both quantitative parameters have incremental value over baseline variables and visually assessed significant stenosis. Potentially, QCT can refine assessment of CAD, which may be of potential use for identification of patients with myocardial ischaemia.


Automated quantification Computed tomography Coronary plaque Myocardial ischaemia Gated single-photon emission computed tomography 



Michiel A. de Graaf is supported by the Dutch Technology Foundation STW, grant 10084. Mark J. Boogers is supported by the Dutch Heart Foundation, grant 2006T102. Caroline E. Veltman is financially supported by a research grant from the Interuniversity Cardiology Institute of The Netherlands (ICIN, Utrecht, The Netherlands). The department of Cardiology received research grants from Biotronik, Medtronic, Boston Scientific Corporation, St Jude Medical, Lantheus Medical Imaging and GE Healthcare. This work was supported by SenterNovem, Ministry of Economic Affairs, The Hague, The Netherlands (project ADVANCE ISO 44070) and the Dutch Technology Foundation STW, Utrecht, The Netherlands (grant 10084). Hans Reiber is the Chief Executive Officer of Medis medical imaging systems B.V. and Professor of Medical Imaging at the Leiden University Medical Centre.

Conflicts of interest

The remaining authors have no conflicts of interest to disclose.


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Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  • Michiel A. de Graaf
    • 1
    • 2
  • Heba M. El-Naggar
    • 1
  • Mark J. Boogers
    • 1
    • 2
  • Caroline E. Veltman
    • 1
    • 2
  • Alexander Broersen
    • 3
  • Pieter H. Kitslaar
    • 3
  • Jouke Dijkstra
    • 3
  • Lucia J. Kroft
    • 4
  • Imad Al Younis
    • 5
  • Johan H. Reiber
    • 3
    • 6
  • Jeroen J. Bax
    • 1
  • Victoria Delgado
    • 1
  • Arthur J. Scholte
    • 1
    • 7
    Email author
  1. 1.Department of CardiologyLeiden University Medical CenterLeidenThe Netherlands
  2. 2.The Interuniversity Cardiology Institute of The NetherlandsUtrechtThe Netherlands
  3. 3.Department of Radiology, Division of Image ProcessingLeiden University Medical CenterLeidenThe Netherlands
  4. 4.Department of RadiologyLeiden University Medical CenterLeidenThe Netherlands
  5. 5.Department of Nuclear MedicineLeiden University Medical CenterLeidenThe Netherlands
  6. 6.Medis medical imaging systems B.V.LeidenThe Netherlands
  7. 7.Department of CardiologyLeiden University Medical CenterLeidenThe Netherlands

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