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Diagnostic performance of fusion of myocardial perfusion imaging (MPI) and computed tomography coronary angiography

Journal of Nuclear Cardiology volume 16, pages 201–211 (2009)Cite this article

Abstract

Background

We evaluated the incremental diagnostic value of fusion images of coronary computed tomography angiography (CTA) and myocardial perfusion imaging (MPI) over MPI alone or MPI and CTA side-by-side to identify obstructive coronary artery disease (CAD > 50% stenosis) using invasive coronary angiography (ICA) as the gold standard.

Methods

50 subjects (36 men; 56 ± 11 years old) underwent rest-stress MPI and CTA within 12-26 days of each other. CTAs were performed with multi-detector CT-scanners (31 on 64-slice; and 19 on 16-slice). 37 patients underwent ICA while 13 subjects did not because of low (<5%) pre-test likelihood (LLK) of disease. Three blinded readers scored the images in sequential sessions using (1) MPI alone (2) MPI and CTA side-by-side, (3) fused CTA/MPI images.

Results

One or more critical stenoses during ICA were found in 28 patients and non-critical stenoses were found in 9 patients. MPI, side-by-side MPI-CTA, and fused CTA/MPI showed the same normalcy rate (NR:13/13) in LLK subjects. The fusion technique performed better than MPI and MPI and CTA side-by-side for the presence of CAD in any vessel (overall area under the curve (AUC) for fused images: 0.89; P = .005 vs MPI, P = .04 vs side-by-side MPI-CTA) and for localization of CAD to the left anterior descending coronary artery (AUC: 0.82, P < .001 vs MPI; P = .007 vs side-by-side MPI-CTA). There was a non-significant trend for better detection of multi-vessel disease with fusion.

Conclusions

Using ICA as the gold standard, fusion imaging provided incremental diagnostic information compared to MPI alone or side-by-side MPI-CTA for the diagnosis of obstructive CAD and for localization of CAD to the left anterior descending coronary artery.

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Acknowledgments

This work was funded in part by General Electric healthcare LTD; National Institute of Health, NHLBI grant number K01 HL70422; Carlos III Institute; Thematic networks of cooperative research, (Red C03/01, RECAVA), and National Institute of Health; NHLBI grant number R01 HL085417. Two of the authors (TLF, EVG) receive royalties from the sale of the Emory Cardiac Toolbox™ utilized to conduct the research described in this article. The terms of this arrangement have been reviewed and approved by Emory University in accordance with it is conflict-of-interest practice.

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Affiliations

  1. Department of Radiology, Emory University, 1365 Clifton Road NE, AT-504, Atlanta, GA, 30322, USA

    Cesar A. Santana MD, Ernest V. Garcia PhD, Tracy L. Faber PhD, Gopi K. R. Sirineni MD, Fabio P. Esteves MD, Rupan Sanyal MD, Raghuveer Halkar MD, Mario Ornelas MD, Liudmila Verdes MD & Paolo Raggi MD

  2. Division of Cardiology, Emory University, Atlanta, GA, USA

    Stamatios Lerakis MD, Julie J. Ramos MD & Paolo Raggi MD

  3. Department of Nuclear Medicine, Vall d’ Hebron University Hospital, Barcelona, Spain

    Santiago Aguadé-Bruix MD

  4. Department of Radiology, Vall d’ Hebron University Hospital, Barcelona, Spain

    Hugo Cuéllar MD

  5. Department of Cardiology, Vall d’ Hebron University Hospital, Barcelona, Spain

    Jaume Candell-Riera MD

Authors
  1. Cesar A. Santana MD
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  2. Ernest V. Garcia PhD
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  3. Tracy L. Faber PhD
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  4. Gopi K. R. Sirineni MD
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  5. Fabio P. Esteves MD
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  6. Rupan Sanyal MD
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  7. Raghuveer Halkar MD
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  8. Mario Ornelas MD
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  9. Liudmila Verdes MD
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  10. Stamatios Lerakis MD
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  11. Julie J. Ramos MD
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  12. Santiago Aguadé-Bruix MD
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  13. Hugo Cuéllar MD
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  14. Jaume Candell-Riera MD
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  15. Paolo Raggi MD
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Corresponding author

Correspondence to Paolo Raggi MD.

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Santana, C.A., Garcia, E.V., Faber, T.L. et al. Diagnostic performance of fusion of myocardial perfusion imaging (MPI) and computed tomography coronary angiography. J. Nucl. Cardiol. 16, 201–211 (2009). https://doi.org/10.1007/s12350-008-9019-z

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  • DOI: https://doi.org/10.1007/s12350-008-9019-z

Keywords

  • Myocardial perfusion imaging
  • SPECT
  • PET imaging
  • computed tomography (CT)
  • coronary artery disease
  • diagnostic and prognostic application