Diagnostic accuracy of combined coronary angiography and adenosine stress myocardial perfusion imaging using 320-detector computed tomography: pilot study

Arthur Nasis, Brian Ko, Michael Chung Hang Leung, Paul Antonis, Dee Nandurkar, Dennis TL Wong, Leo Kyi, James Donald Cameron, John Troupis, Ian T Meredith, Sujith Seneviratne

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52 Citations (Scopus)

Abstract

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). METHODS: 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. RESULTS: 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). CONCLUSIONS: 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. KEY POINTS: * 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 establi
Original languageEnglish
Pages (from-to)1812 - 1821
Number of pages10
JournalEuropean Radiology
Volume23
Issue number7
DOIs
Publication statusPublished - 2013

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