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Corrected coronary opacification decrease from coronary computed tomography angiography: Validation with quantitative 13N-ammonia positron emission tomography

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Journal of Nuclear Cardiology Aims and scope

Abstract

Background

To assess the functional relevance of a coronary artery stenosis, corrected coronary opacification (CCO) decrease derived from coronary computed tomography angiography (CCTA) has been proposed. The present study aims at validating CCO decrease with quantitative 13N-ammonia positron emission tomography (PET) myocardial perfusion imaging (MPI).

Methods and Results

This retrospective study consists of 39 patients who underwent hybrid CCTA/PET-MPI. From CCTA, attenuation in the coronary lumen was measured before and after a stenosis and corrected to the aorta to calculate CCO and its decrease. Relative flow reserve (RFR) was calculated by dividing the stress myocardial blood flow (MBF) of a vessel territory subtended by a stenotic coronary by the stress MBF of the reference territories without stenoses. RFR was abnormal in 11 vessel territories (27%). CCO decrease yielded a sensitivity, specificity, negative predictive value, positive predictive value, and accuracy for prediction of an abnormal RFR of 73%, 70%, 88%, 47%, and 70%, respectively.

Conclusions

CCTA-derived CCO decrease has moderate diagnostic accuracy to predict an abnormal RFR in PET-MPI. However, its high negative predictive value to rule out functional relevance of a given lesion may confer clinical implications in the diagnostic work-up of patients with a coronary stenosis.

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Abbreviations

CCO:

Corrected coronary opacification

CCTA:

Coronary computed tomography angiography

SPECT:

Single photon emission computed tomography

PET:

Positron emission tomography

RFR:

Relative flow reserve

MBF:

Myocardial blood flow

CFR:

Coronary flow reserve

TAC:

Time-activity curves

ICA:

Invasive coronary angiography

PCI:

Percutaneous coronary intervention

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Acknowledgments

We thank Verena Weichselbaumer, Martina Vogt, Tania Lagrange, Lasien Vojo, and Kevin Frei for their excellent technical support.

Disclosure

The authors do not have any personal conflicts of interest to declare. However, the University Hospital Zurich holds a research agreement with GE Healthcare.

Author information

Authors and Affiliations

  1. Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Ramistrasse 100, 8091, Zurich, Switzerland

    Dominik C. Benz MD, Christoph Gräni MD, Paola Ferro MD, Luis Neumeier, Michael Messerli MD, Mathias Possner MD, Olivier F. Clerc MD, Catherine Gebhard MD, Oliver Gaemperli MD, Aju P. Pazhenkottil MD, Philipp A. Kaufmann MD & Ronny R. Buechel MD

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  1. Dominik C. Benz MD
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  2. Christoph Gräni MD
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  3. Paola Ferro MD
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Corresponding author

Correspondence to Ronny R. Buechel MD.

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Dominik C. Benz and Christoph Gräni share first authorship; Philipp A. Kaufmann and Ronny R. Buechel share last authorship

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Benz, D.C., Gräni, C., Ferro, P. et al. Corrected coronary opacification decrease from coronary computed tomography angiography: Validation with quantitative 13N-ammonia positron emission tomography. J. Nucl. Cardiol. 26, 561–568 (2019). https://doi.org/10.1007/s12350-017-0980-2

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  • DOI: https://doi.org/10.1007/s12350-017-0980-2

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