The emerging role of cardiac computed tomography for the assessment of coronary perfusion: a systematic review and meta-analysis

Background

Computed tomography perfusion (CTP) is an emerging method which, coupled with the anatomical detail afforded by cardiac computed tomographic angiography (CCTA), may allow for determination of both structural and physiologic significance of coronary stenoses with a single imaging modality. This study was designed to execute a systematic review/meta-analysis to determine the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of CTP as compared with reference standards for detection of significant coronary artery stenoses and impaired perfusion.

Methods

A systematic review identified 13 out of 4368 studies allowing a calculation of sensitivity, specificity, PPV, and NPV on a per patient or per vessel or per segment basis using radionuclide myocardial perfusion imaging (MPI), conventional coronary angiography (CCA), magnetic resonance perfusion imaging (MRPI), or fractional flow reserve (FFR) as the reference standard. Meta-analyses of results were carried out using random effects modelling.

Results

Most studies used a maximal vasodilator stress protocol with adenosine, provided information mainly on a per vessel basis, and used myocardial perfusion imaging or CCA as the reference standard. Of the studies comparing combinations of both anatomical and functional imaging, the most rigourous standard was CCA/FFR. Compared with the latter, CCTA/CTP had sensitivity, specificity, PPV, and NPV of 81%, 93%, 87%, and 88%, respectively.

Conclusions

CTP shows promise as an adjunct to CCTA, potentially allowing determination of both structural and physiologic significance with a single imaging modality.