Diagnostic accuracy of combined coronary angiography and adenosine stress myocardial perfusion imaging using 320-detector computed tomography: pilot study
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).
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.
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).
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.
• 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.
KeywordsCoronary artery disease Multidetector computed tomography Adenosine stress myocardial perfusion Single-photon emission computed tomography Myocardial ischaemia
Coronary artery disease
Computed tomography coronary angiography
Computed tomography stress myocardial perfusion imaging
Single-photon emission computed tomography myocardial perfusion imaging
Quantitative coronary angiography
Summed rest score
Summed stress score
Left anterior descending
Right coronary artery
Positive predictive value
Negative predictive value
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.
- 5.Hachamovitch R, Hayes S, Friedman J et al (2003) Comparison of the short-term survival benefit associated with revascularization compared with medical therapy in patients with no prior coronary artery disease undergoing stress myocardial perfusion single photon emission computed tomography. Circulation 107:2900–2907PubMedCrossRefGoogle Scholar
- 6.Shaw L, Berman D, Maron D et al (2008) Optimal medical therapy with or without percutaneous coronary intervention to reduce ischemic burden: results from the Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation (COURAGE) trial nuclear substudy. Circulation 117:1283–1291PubMedCrossRefGoogle Scholar
- 7.Schuhbäck A, Marwan M, Gauss S et al (2012) Interobserver agreement for the detection of atherosclerotic plaque in coronary CT angiography: comparison of two low-dose image acquisition protocols with standard retrospectively ECG-gated reconstruction. Eur Radiol 22:1529–1536PubMedCrossRefGoogle Scholar
- 8.Budoff M, Dowe D, Jollis J et al (2008) Diagnostic performance of 64-multidetector row coronary computed tomographic angiography for evaluation of coronary artery stenosis in individuals without known coronary artery disease: results from the prospective multicenter ACCURACY (Assessment by Coronary Computed Tomographic Angiography of Individuals Undergoing Invasive Coronary Angiography) trial. J Am Coll Cardiol 52:1724–1732PubMedCrossRefGoogle Scholar
- 9.Dewey M, Zimmermann E, Deissenrieder F et al (2009) Noninvasive coronary angiography by 320-row computed tomography with lower radiation exposure and maintained diagnostic accuracy: comparison of results with cardiac catheterization in a head-to-head pilot investigation. Circulation 120:867–875PubMedCrossRefGoogle Scholar
- 10.Neefjes L, Rossi A, Genders T et al (2012) Diagnostic accuracy of 128-slice dual-source CT coronary angiography: a randomized comparison of different acquisition protocols. Eur Radiol 23:614-622Google Scholar
- 16.George R, Arbab-Zadeh A, Miller J et al (2009) Adenosine stress 64- and 256-row detector computed tomography angiography and perfusion imaging: a pilot study evaluating the transmural extent of perfusion abnormalities to predict atherosclerosis causing myocardial ischemia. Circ Cardiovasc Imaging 2:174–182PubMedCrossRefGoogle Scholar
- 21.Cerqueira M, Weissman N, Dilsizian V et al (2002) Standardized myocardial segmentation and nomenclature for tomographic imaging of the heart: a statement for healthcare professionals from the Cardiac Imaging Committee of the Council on Clinical Cardiology of the American Heart Association. Circulation 105:539–542PubMedCrossRefGoogle Scholar
- 32.Taylor A, Cerqueira M, Hodgson J et al (2010) ACCF/SCCT/ACR/AHA/ASE/ASNC/NASCI/SCAI/SCMR 2010 Appropriate use criteria for Cardiac Computed Tomography. A Report of the American College of Cardiology Foundation Appropriate Use Criteria Task Force, the Society of Cardiovascular Computed Tomography, the American College of Radiology, the American Heart Association, the American Society of Echocardiography, the American Society of Nuclear Cardiology, the North American Society for Cardiovascular Imaging, the Society for Cardiovascular Angiography and Interventions, and the Society for Cardiovascular Magnetic Resonance. J Cardiovasc Comput Tomogr 4:e1–e33PubMedCrossRefGoogle Scholar
- 35.Jung P, Rieber J, Stork S et al (2008) Effect of contrast application on interpretability and diagnostic value of dobutamine stress echocardiography in patients with intermediate coronary lesions: comparison with myocardial fractional flow reserve. Eur Heart J 29:2536–2543PubMedCrossRefGoogle Scholar
- 38.Vavere A, Simon G, George R et al (2011) Diagnostic performance of combined noninvasive coronary angiography and myocardial perfusion imaging using 320 row detector computed tomography: design and implementation of the CORE320 multicenter, multinational diagnostic study. J Cardiovasc Comput Tomogr 5:370–381PubMedCrossRefGoogle Scholar