Dynamic Myocardial Perfusion CT for the Detection of Hemodynamically Significant Coronary Artery Disease |
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| Affiliation: | 1. Department of Radiology and Nuclear Medicine, Erasmus University Medical Center, University Medical Center Rotterdam, Rotterdam, the Netherlands;2. Department of Cardiology, Erasmus University Medical Center, University Medical Center Rotterdam, Rotterdam, the Netherlands;3. Department of Cardiology, University of Tuebingen, Tuebingen, Germany;4. Coronary Disease and Structural Heart Diseases Department, Institute of Cardiology, Warsaw, Poland;5. Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland;6. Department of Advanced Diagnostic Imaging, Mie University Graduate School of Medicine, Tsu, Japan;7. Department of Radiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands;8. Department of Cardiology, Faculty of Medicine, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany;9. Department of Cardiology, Ludwig-Maximilians University, Munich, Germany;10. Veterans Affairs Palo Alto Healthcare System, Cardiology Section, Palo Alto, California, USA;11. Stanford University, Division of Cardiovascular Medicine, Stanford, California, USA;12. Stanford Cardiovascular Institute, Stanford, California, USA;13. Department of Radiology, University Hospital of Tübingen, Tübingen, Germany;14. Department of Cardiology, University Heart Center and Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland;15. Department of Radiology, Mie University Graduate School of Medicine, Tsu, Japan;p. Veterans Affairs Palo Alto Healthcare System, Thoracic and Cardiovascular Imaging Section, Palo Alto, California, USA;q. Stanford University, Division of Cardiovascular Imaging (Affiliated), Stanford, California, USA;r. Siemens Healthineers, Forcheim, Germany;s. Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands;t. Centre for Advanced Cardiovascular Imaging, William Harvey Research Institute, Barts National Institute for Health Research Biomedical Research Centre, Queen Mary University of London, London, United Kingdom;u. Barts Heart Centre, St Bartholomew’s Hospital, Barts Health National Health Service Trust, West Smithfield, London, United Kingdom;v. Department of Radiology, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany;w. Stanford University School of Medicine and Cardiovascular Institute, Stanford, California, USA |
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| Abstract: | ObjectivesIn this international, multicenter study, using third-generation dual-source computed tomography (CT), we investigated the diagnostic performance of dynamic stress CT myocardial perfusion imaging (CT-MPI) in addition to coronary CT angiography (CTA) compared to invasive coronary angiography (ICA) and invasive fractional flow reserve (FFR).BackgroundCT-MPI combined with coronary CTA integrates coronary artery anatomy with inducible myocardial ischemia, showing promising results for the diagnosis of hemodynamically significant coronary artery disease in single-center studies.MethodsAt 9 centers in Europe, Japan, and the United States, 132 patients scheduled for ICA were enrolled; 114 patients successfully completed coronary CTA, adenosine-stress dynamic CT-MPI, and ICA. Invasive FFR was performed in vessels with 25% to 90% stenosis. Data were analyzed by independent core laboratories. For the primary analysis, for each coronary artery the presence of hemodynamically significant obstruction was interpreted by coronary CTA with CT-MPI compared to coronary CTA alone, using an FFR of ≤0.80 and angiographic severity as reference. Territorial absolute myocardial blood flow (MBF) and relative MBF were compared using C-statistics.ResultsICA and FFR identified hemodynamically significant stenoses in 74 of 289 coronary vessels (26%). Coronary CTA with ≥50% stenosis demonstrated a per-vessel sensitivity, specificity, and accuracy for the detection of hemodynamically significant stenosis of 96% (95% CI: 91%-100%), 72% (95% CI: 66%-78%), and 78% (95% CI: 73%-83%), respectively. Coronary CTA with CT-MPI showed a lower sensitivity (84%; 95% CI: 75%-92%) but higher specificity (89%; 95% CI: 85%-93%) and accuracy (88%; 95% CI: 84%-92%). The areas under the receiver-operating characteristic curve of absolute MBF and relative MBF were 0.79 (95% CI: 0.71-0.86) and 0.82 (95% CI: 0.74-0.88), respectively. The median dose-length product of CT-MPI and coronary CTA were 313 mGy·cm and 138 mGy·cm, respectively.ConclusionsDynamic CT-MPI offers incremental diagnostic value over coronary CTA alone for the identification of hemodynamically significant coronary artery disease. Generalized results from this multicenter study encourage broader consideration of dynamic CT-MPI in clinical practice. (Dynamic Stress Perfusion CT for Detection of Inducible Myocardial Ischemia [SPECIFIC]; NCT02810795) |
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| Keywords: | computed tomography angiography coronary artery disease fractional flow reserve invasive coronary angiography myocardial ischemia myocardial perfusion imaging AUC" },{" #name" :" keyword" ," $" :{" id" :" kwrd0045" }," $$" :[{" #name" :" text" ," _" :" area under the receiver-operating characteristic curve CAD" },{" #name" :" keyword" ," $" :{" id" :" kwrd0055" }," $$" :[{" #name" :" text" ," _" :" coronary artery disease CT" },{" #name" :" keyword" ," $" :{" id" :" kwrd0065" }," $$" :[{" #name" :" text" ," _" :" computed tomography CTA" },{" #name" :" keyword" ," $" :{" id" :" kwrd0075" }," $$" :[{" #name" :" text" ," _" :" computed tomography angiography CT-MPI" },{" #name" :" keyword" ," $" :{" id" :" kwrd0085" }," $$" :[{" #name" :" text" ," _" :" computed tomography myocardial perfusion imaging FFR" },{" #name" :" keyword" ," $" :{" id" :" kwrd0095" }," $$" :[{" #name" :" text" ," _" :" fractional flow reserve ICA" },{" #name" :" keyword" ," $" :{" id" :" kwrd0105" }," $$" :[{" #name" :" text" ," _" :" invasive coronary angiography MBF" },{" #name" :" keyword" ," $" :{" id" :" kwrd0125" }," $$" :[{" #name" :" text" ," _" :" myocardial blood flow NPV" },{" #name" :" keyword" ," $" :{" id" :" kwrd0135" }," $$" :[{" #name" :" text" ," _" :" negative predictive value PPV" },{" #name" :" keyword" ," $" :{" id" :" kwrd0145" }," $$" :[{" #name" :" text" ," _" :" positive predictive value QCA" },{" #name" :" keyword" ," $" :{" id" :" kwrd0155" }," $$" :[{" #name" :" text" ," _" :" quantitative coronary angiography |
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