Comparison of the Extent and Severity of Myocardial Perfusion Defects Measured by CT Coronary Angiography and SPECT Myocardial Perfusion Imaging

Tamarappoo, Balaji; Dey, Damini; Nakazato, Ryo; Shmilovich, Haim; Smith, Thomas W R; Cheng, Victor; Thomson, Louise; Hayes, Sean W.; Friedman, John D.; Germano, Guido; Slomka, Piotr J.; Berman, Daniel S.

doi:10.1016/j.jcmg.2010.07.011

Cited by 68 publications

(42 citation statements)

References 32 publications

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“…Accordingly, combined ICA/ CMR-MPI is sufficient as a reference standard for collecting anatomical and physiological information regarding coronary stenosis. CTP has been widely investigated using various CT scanners, acquisition protocols, study populations, and reference standards and is considered a promising method for imaging myocardial ischemia, comparable to SPECT and CMR-MPI [7][8][9][10][11][12][13][14]. Bettencourt et al [14] demonstrated that CTP is globally inferior to CMR-MPI; however, integrating CTP and CCTA showed similar diagnostic performance to CMR-MPI using FFR as the reference standard for detecting hemodynamically significant CAD.…”

Section: Discussionmentioning

confidence: 99%

“…Myocardial perfusion on routine or single-shot CTP is assessed using semi-quantitative metrics such as the transmural perfusion ratio and visual perfusion assessment [7][8][9][10][11][12][13][14]. Mapping the iodine distribution within the left ventricular myocardium is possible with DECT.…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, less than half of high-grade stenoses identified using CCTA physiologically cause myocardial ischemia, and concerns have arisen that the use of CCTA-identified coronary artery disease (CAD) may precipitate high rates of unnecessary ICA [5,6]. To address these limitations, pharmacological CT myocardial perfusion imaging (MPI) has emerged as an additional CT method for diagnosing myocardial ischemia and showed satisfactory diagnostic performance compared with single photon emission computed tomography (SPECT)-MPI, fractional flow reserve (FFR), a combination of ICA and SPECT-MPI, and a combination of ICA and cardiac magnetic resonance (CMR)-MPI [7][8][9][10][11][12][13][14]. However, these investigations have been largely limited to the use of single-energy CT, which relies on relative Hounsfield unit density measurements to detect myocardial perfusion deficits.…”

Section: Introductionmentioning

confidence: 99%

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Stress Dual-Energy Computed Tomography-Myocardial Perfusion Imaging to Identify Coronary Artery Stenoses Causing Ischemia: A Direct Comparison between Invasive Coronary Angiography and Cardiac Magnetic Resonance-Myocardial Perfusion Imaging

Song

Hwang

et al. 2017

Cardiovasc Imaging Asia

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Objective:We determined the diagnostic performance of stress dual-energy computed tomography-myocardial perfusion imaging (DECT-MPI) for diagnosing coronary artery stenoses causing ischemia. Materials and Methods:Institutional review board approval and informed patient consent were obtained before patient enrollment in the study. One hundred ninety-two consecutive patients (135 males, 63.1±8.0 years) underwent coronary computed tomography angiography (CCTA), stress DECT-MPI, and a combined invasive coronary angiography (ICA)/cardiac magnetic resonance-myocardial perfusion imaging (CMR-MPI) for further comparison. Stress DECT-MPI and CMR-MPI were evaluated for perfusion deficits, whereas CCTA and ICA were evaluated for coronary stenosis ≥50%. The primary endpoint was the diagnostic performance of combined CCTA/stress DECT-MPI compared with combined ICA/CMR-MPI at the per-vessel level. Individual direct comparisons of CCTA to ICA and stress DECT-MPI to CMR-MPI were explored. Results:One hundred forty-four (75%) patients and 257 (45%) vascular territories manifested ischemia-causing coronary stenoses based on combined ICA/CMR-MPI. Per-vessel sensitivity, specificity, positive predictive value, and negative predictive value of combined CCTA/stress DECT-MPI were 88, 82, 79, and 89%, respectively, compared with combined ICA/ CMR-MPI. The values for CCTA alone were 95, 45, 63, and 94%, respectively, and the values for stress DECT-MPI alone were 91, 75, 75, and 92%, respectively. The area under the receiver operating characteristics curve for combined CCTA/stress DECT-MPI was higher than that for CCTA alone (0.85 vs. 0.75, p=0.001). Conclusion:When compared with combined ICA/CMR-MPI, combined CCTA/stress DECT-MPI improved the predictive value for coronary stenoses causing ischemia compared with CCTA, but only mildly improved the diagnostic performance of stress DECT-MPI alone.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Stress Dual-Energy Computed Tomography-Myocardial Perfusion Imaging to Identify Coronary Artery Stenoses Causing Ischemia: A Direct Comparison between Invasive Coronary Angiography and Cardiac Magnetic Resonance-Myocardial Perfusion Imaging

Song

Hwang

et al. 2017

Cardiovasc Imaging Asia

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“…Our data showed that sensitivity (81%) of combined CCTA and ASDCTP was higher than the threshold of $50% diameter stenosis on CCTA and their specificity (99%) was higher than the threshold of $70% diameter stenosis and the accuracies ($93%) were higher than both thresholds. Recent studies have demonstrated the feasibility of adenosine-induced CTP using static or dynamic scanning for detecting perfusion defects compared with SPECT or cardiac MRI [7,[13][14][15][23][24][25][26][27][28]. Among them, two studies of dynamic CTP using 128-slice DSCT reported high sensitivity (86.1%) and specificity (98.2%) compared with cardiac MRI as the reference standard [13,15].…”

Section: Discussionmentioning

confidence: 99%

Detection of ischaemic myocardial lesions with coronary CT angiography and adenosine-stress dynamic perfusion imaging using a 128-slice dual-source CT: diagnostic performance in comparison with cardiac MRI

Kim

Jh²,

Chang³

et al. 2013

BJR

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Detection of ischaemic myocardial lesions with coronary CT angiography and adenosine-stress dynamic perfusion imaging using a 128-slice dual-source CT: diagnostic performance in comparison with cardiac MRI. Br J Radiol 2013;86: 20130481. FULL PAPER Detection of ischaemic myocardial lesions with coronary CT angiography and adenosine-stress dynamic perfusion imaging using a 128-slice dual-source CT: diagnostic performance in comparison with cardiac MRI Objective: We assessed the diagnostic performance of adenosine-stress dynamic CT perfusion (ASDCTP) imaging and coronary CT angiography (CCTA) for the detection of ischaemic myocardial lesions using 128-slice dual-source CT compared with that of 1.5 T cardiac MRI.Methods: This prospective study included 33 patients (6168 years, 82% male) with suspected coronary artery diseases who underwent ASDCTP imaging and adenosine-stress cardiac MRI. Two investigators independently evaluated ASDCTP images in correlation with significant coronary stenosis on CCTA using two different thresholds of 50% and 70% diameter stenosis. Hypoattenuated myocardial lesions on ASDCTP associated with significant coronary stenoses on CCTA were regarded as true perfusion defects. All estimates of diagnostic performance were calculated and compared with those of cardiac MRI.Results: With use of a threshold of 50% diameter stenosis on CCTA, the diagnostic estimates per-myocardial segment were as follows: sensitivity, 81% [95% confidence interval (CI): 70-92%]; specificity, 94% (95% CI: 92-96%); and accuracy 93% (95% CI: 91-95%). With use of a threshold of 70%, the diagnostic estimates were as follows: sensitivity, 48% (95% CI: 34-62%); specificity, 99% (95% CI: 98-100%); and accuracy, 94% (95% CI: 92-96%). Conclusion: Dynamic CTP using 128-slice dual-source CT enables the assessment of the physiological significance of coronary artery lesions with high diagnostic accuracy in patients with clinically suspected coronary artery disease. Advances in knowledge: Combined CCTA and ASDCTP yielded high accuracy in the detection of perfusion defects regardless of the threshold of significant coronary stenosis.It is important to evaluate not only anatomical information about coronary arteries but also physiological information about myocardial perfusion for the precise assessment of coronary artery disease (CAD) [1]. Myocardial perfusion imaging (MPI) can provide haemodynamic information during exercise-induced or pharmacological stress. Singlephoton emission tomography (SPECT), cardiac MRI or positron emission tomography (PET) has been extensively used for MPI [2,3]. Moreover, a normal MPI determined using these techniques carries an excellent prognosis with a low rate of cardiac events [4][5][6].SPECT and PET are limited in their ability to evaluate coronary artery morphology and cardiac structures. By contrast, CT MPI with coronary CTangiography (CCTA) can evaluate not only anatomical structure, including coronary artery morphology, but also myocardial perfusion status. Although radiation dose associa...

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“…In the study of Schuijf et al, myocardial perfusion imaging compared to invasive coronary angiography had less accuracy for detecting CAD (24), while in another study by Li et al, there was no significant difference between sensitivity, specificity, and accuracy of MPI compared to Computerized Tomography (CT) coronary angiography in diagnosing CAD, and both had good diagnostic performance for CAD (25). Tamarappoo et al showed that extent and severity of myocardial perfusion defects, measured by CT coronary angiography had a strong similarity with SPECT myocardial perfusion imaging (26).…”

Section: Introductionmentioning

confidence: 99%

Evaluation of the Correlation Between Myocardial Perfusion Scan Findings and Invasive Coronary Angiography Results

Eskandarian

Razavi

Safaei

et al. 2017

Middle East J Rehabil Health Stud

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Background: Non-invasive and cost effective treatments of coronary artery disease (CAD) are a health priority and a current necessity. Objectives: This study aimed at comparing the results of myocardial perfusion imaging (MPI) with coronary angiography findings in the diagnosis of CAD. Methods: This cross sectional study included 155 patients with stable angina, who were referred to Kowsar hospital, Semnan, Iran, from May 2013 to April 2014. After confirmation of positive perfusion imaging, angiography was performed within 3 months. Myocardial perfusion imaging results were categorized as mild, moderate and severe, and also in coronary angiography, narrowing of more than 50% of the vessels was considered as significant stenosis.

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Comparison of the Extent and Severity of Myocardial Perfusion Defects Measured by CT Coronary Angiography and SPECT Myocardial Perfusion Imaging

Cited by 68 publications

References 32 publications

Stress Dual-Energy Computed Tomography-Myocardial Perfusion Imaging to Identify Coronary Artery Stenoses Causing Ischemia: A Direct Comparison between Invasive Coronary Angiography and Cardiac Magnetic Resonance-Myocardial Perfusion Imaging

Stress Dual-Energy Computed Tomography-Myocardial Perfusion Imaging to Identify Coronary Artery Stenoses Causing Ischemia: A Direct Comparison between Invasive Coronary Angiography and Cardiac Magnetic Resonance-Myocardial Perfusion Imaging

Detection of ischaemic myocardial lesions with coronary CT angiography and adenosine-stress dynamic perfusion imaging using a 128-slice dual-source CT: diagnostic performance in comparison with cardiac MRI

Evaluation of the Correlation Between Myocardial Perfusion Scan Findings and Invasive Coronary Angiography Results

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