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European Radiology

, Volume 23, Issue 7, pp 1812–1821 | Cite as

Diagnostic accuracy of combined coronary angiography and adenosine stress myocardial perfusion imaging using 320-detector computed tomography: pilot study

  • Arthur Nasis
  • Brian S. Ko
  • Michael C. Leung
  • Paul R. Antonis
  • Dee Nandurkar
  • Dennis T. Wong
  • Leo Kyi
  • James D. Cameron
  • John M. Troupis
  • Ian T. Meredith
  • Sujith K. SeneviratneEmail author
Cardiac

Abstract

Objectives

To determine the diagnostic accuracy of combined 320-detector row computed tomography coronary angiography (CTA) and adenosine stress CT myocardial perfusion imaging (CTP) in detecting perfusion abnormalities caused by obstructive coronary artery disease (CAD).

Methods

Twenty patients with suspected CAD who underwent initial investigation with single-photon-emission computed tomography myocardial perfusion imaging (SPECT-MPI) were recruited and underwent prospectively-gated 320-detector CTA/CTP and invasive angiography. Two blinded cardiologists evaluated invasive angiography images quantitatively (QCA). A blinded nuclear physician analysed SPECT-MPI images for fixed and reversible perfusion defects. Two blinded cardiologists assessed CTA/CTP studies qualitatively. Vessels/territories with both >50 % stenosis on QCA and corresponding perfusion defect on SPECT-MPI were defined as ischaemic and formed the reference standard.

Results

All patients completed the CTA/CTP protocol with diagnostic image quality. Of 60 vessels/territories, 17 (28 %) were ischaemic according to QCA/SPECT-MPI criteria. Sensitivity, specificity, PPV, NPV and area under the ROC curve for CTA/CTP was 94 %, 98 %, 94 %, 98 % and 0.96 (P < 0.001) on a per-vessel/territory basis. Mean CTA/CTP radiation dose was 9.2 ± 7.4 mSv compared with 13.2 ± 2.2 mSv for SPECT-MPI (P < 0.001).

Conclusions

Combined 320-detector CTA/CTP is accurate in identifying obstructive CAD causing perfusion abnormalities compared with combined QCA/SPECT-MPI, achieved with lower radiation dose than SPECT-MPI.

Key Points

Advances in CT technology provides comprehensive anatomical and functional cardiac information.

Combined 320-detector CTA/adenosine-stress CTP is feasible with excellent image quality.

Combined CTA/CTP is accurate in identifying myocardial ischaemia compared with QCA/SPECT-MPI.

Combined CTA/CTP results in lower patient radiation exposure than SPECT-MPI.

CTA/CTP may become an established imaging technique for suspected CAD.

Keywords

Coronary artery disease Multidetector computed tomography Adenosine stress myocardial perfusion Single-photon emission computed tomography Myocardial ischaemia 

Abbreviations

CAD

Coronary artery disease

CTA

Computed tomography coronary angiography

CTP

Computed tomography stress myocardial perfusion imaging

SPECT-MPI

Single-photon emission computed tomography myocardial perfusion imaging

QCA

Quantitative coronary angiography

SRS

Summed rest score

SSS

Summed stress score

LAD

Left anterior descending

LCx

Left circumflex

RCA

Right coronary artery

PPV

Positive predictive value

NPV

Negative predictive value

ROC

Receiver-operator characteristic

Notes

Funding Sources

Dr Arthur Nasis currently holds research scholarships from the National Health and Medical Research Council (NHMRC), the National Heart Foundation of Australia and the Southern Health Senior Medical Staff Association.

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Copyright information

© European Society of Radiology 2013

Authors and Affiliations

  • Arthur Nasis
    • 1
  • Brian S. Ko
    • 1
  • Michael C. Leung
    • 1
  • Paul R. Antonis
    • 1
  • Dee Nandurkar
    • 2
  • Dennis T. Wong
    • 1
  • Leo Kyi
    • 1
  • James D. Cameron
    • 1
  • John M. Troupis
    • 2
  • Ian T. Meredith
    • 1
  • Sujith K. Seneviratne
    • 1
    Email author
  1. 1.Monash Cardiovascular Research Centre, Monash Heart, Department of Medicine Monash Medical Centre (MMC)Southern Health and Monash UniversityMelbourneAustralia
  2. 2.Department of Diagnostic ImagingMMC, Southern HealthMelbourneAustralia

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