The combination of CTA and perfusion correctly identifies patients with flow limiting CAD defined as ≥50 stenosis by ICA causing a perfusion defect by SPECT/MPI.

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OBJECTIVE Coronary MDCT angiography has been shown to be an accurate noninvasive tool for the diagnosis of obstructive coronary artery disease (CAD). Its sensitivity and negative predictive value for diagnosing percentage of stenosis are unsurpassed compared with those of other noninvasive testing methods. However, in its current form, it provides no information regarding the physiologic impact of CAD and is a poor predictor of myocardial ischemia. CORE320 is a multicenter multinational diagnostic study with the primary objective to evaluate the diagnostic accuracy of 320-MDCT for detecting coronary artery luminal stenosis and corresponding myocardial perfusion deficits in patients with suspected CAD compared with the reference standard of conventional coronary angiography and SPECT myocardial perfusion imaging. CONCLUSION We aim to describe the CT acquisition, reconstruction, and analysis methods of the CORE320 study.

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A ppropriate clinical decisions concerning diagnosis and treatment of coronary artery disease rely on the correct integration of data on coronary anatomy and myocardial perfusion.1 Revascularization of coronary stenosis is only justified if it relieves angina complaints and improves patient outcome, which depends on the extent and severity of inducible myocardial ischemia related to the lesion. 2-5 Clinical Perspective on p 595In clinical practice, conventional coronary angiography (CCA) and single-photon emission tomography myocardial perfusion imaging (single-photon emission computed tomography [SPECT]) are the standard imaging methods for detection and quantification of coronary artery stenosis and myocardial perfusion defects. To define a treatment strategy, physicians must mentally create a correlation map, merging the anatomical data from CCA, a projection-imaging method, with the functional data from SPECT, a mix of projection and tomographic imaging methods, overcoming image foreshortening, differences on image-acquisition times, and differences in spatial and temporal resolution between the methods.Myocardial perfusion defects have also been assigned to vascular territories using left ventricular segmentation models. [6][7][8] This approach is usually applied in research settings, where standardization between different imaging methods is attempted. However, standard assumptions about the vascular territory distribution in myocardial perfusion analysis are frequently inaccurate because of morphologic variability in the Background-Appropriate clinical decisions concerning diagnosis and treatment of coronary artery disease rely on correct integration of data on coronary anatomy and myocardial perfusion. The purpose of this article is to introduce a new left ventricular segmentation model for improved alignment of coronary arterial segments and myocardial perfusion territories, designed for the CORE320 study. Methods and Results-CORE320 is a prospective, multicenter study with a primary objective to evaluate the diagnostic accuracy of 320-row detector computed tomography (CT) to detect coronary artery luminal stenosis and corresponding myocardial perfusion deficits in patients with suspected coronary artery disease compared with the gold standard of conventional coronary angiography and single-photon emission CT myocardial perfusion imaging. We describe a 19-coronary segment and 13-myocardial territory alignment model, its application in both standard and CT image data sets, and the adjudication process of the initial cohort of patients recruited for the CORE320 study. Adjudication committees reviewed the images of the first 101 gold standard and 107 CT data sets. On the basis of the presented model and rules, all cases for adjudication were correctly identified. During image review, 6 (5.9%) gold standard and 9 (8.4%) CT data sets needed further realignment not triggered by the algorithm. Conclusions-We present a vascular territory distribution model developed for the CORE320 multicenter study, which acco...

SPECT-MPI added significant incremental prognostic information to clinical and left ventricular functional variables while enhancing the ability to classify this Brazilian female population into low- and high-risk categories of all-cause mortality.