Impact of scan quality on the diagnostic performance of CCTA,SPECT, and PET for diagnosing myocardial ischemia defined by fractional flow reserve |
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| Institution: | 1. Department of Cardiology, Amsterdam UMC location: VU University Medical Center, Amsterdam, the Netherlands;2. Department of Radiology, Nuclear Medicine & PET Research, Amsterdam UMC location: VU University Medical Center, Amsterdam, the Netherlands;3. Institute for Cardiovascular Imaging, Weill-Cornell Medical College, New York-Presbyterian Hospital, New York, United States of America;4. Department of Medicine & Radiology, University of British Columbia, Vancouver, Canada;5. Turku PET Centre, Turku University Hospital and University of Turku, Turku, Finland;6. Department of Nuclear Medicine, Royal Brompton Hospital, London, United Kingdom;7. Department of Epidemiology & Biostatistics, Amsterdam UMC location: VU University Medical Center, Amsterdam, the Netherlands;1. Department of Cardiology, Munich University Clinic, Ludwig-Maximilians University, Germany;2. Department of Radiology, Munich University Clinic, Ludwig-Maximilians University, Germany;3. Department of Cardiology and Intensive Care Medicine, Heart Center Munich Bogenhausen, Germany;4. Munich Heart Alliance at DZHK, Munich, Germany;5. Medizinisches Versorgungszentrum Hattingen, Germany;1. Servicio de Cardiología, Hospital Clínico San Carlos, Madrid, Spain;2. Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain |
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| Abstract: | BackgroundScan quality can have a significant effect on the diagnostic performance of non-invasive imaging techniques. However, the extent of its influence has scarcely been investigated in a head-to-head manner.MethodsTwo-hundred and eight patients underwent CCTA, SPECT, and PET prior to invasive fractional flow reserve measurements. Scan quality was classified as either good, moderate, or poor.ResultsDistribution of good, moderate, and poor quality scans was; CCTA; 66%, 22%, 13%; SPECT; 52%, 38%, 9%; PET; 86%, 13%, 1%. Good quality CCTA scans possessed a higher specificity (75% vs. 31%, p = 0.001), positive predictive value (PPV, 71% vs. 51%, p = 0.050), and accuracy (80% vs. 60%, p = 0.009) compared to moderate quality scans, while sensitivity (94%) and negative predictive value (NPV, 88%) were similar to moderate and poor quality scans. Sensitivity (76%), NPV (84%), and accuracy (85%) of good quality SPECT scans was superior to those of moderate (41% p = 0.001, 56% p = 0.010, 70% p = 0.010) and poor quality (30% p = 0.003, 65% p = 0.069, 63% p = 0.038). Specificity (92%) and PPV (87%) of good quality SPECT scans did not differ from scans of diminished quality. Good quality PET scans exhibited high sensitivity (84%), specificity (86%), NPV (88%), PPV (81%) and accuracy (85%), which was comparable to scans of lesser quality. Good quality CCTA, SPECT, and PET scans demonstrated a similar diagnostic accuracy (p = 0.247).ConclusionDiagnostic performance of CCTA, and SPECT is hampered by scan quality, while the diagnostic value of PET is not affected. Good quality CCTA, SPECT, and PET scans possess a high diagnostic accuracy. |
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| Keywords: | Coronary artery disease Fractional flow reserve Coronary computed tomography angiography Single photon emission computed tomography Positron emission tomography |
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