Recently, stress myocardial computed tomographic perfusion (CTP) was shown to detect
myocardial ischemia. Our main objective was to evaluate the feasibility of dipyridamole
stress CTP and compare it to single-photon emission computed tomography (SPECT) to
detect significant coronary stenosis using invasive conventional coronary angiography
(CCA; stenosis >70%) as the reference method. Thirty-six patients (62 ± 8 years old,
20 men) with previous positive results with SPECT (<2 months) as the primary inclusion
criterion and suspected coronary artery disease underwent a customized multidetector-row
CT protocol with myocardial perfusion evaluation at rest and during stress and coronary
CT angiography (CTA). Multidetector-row computed tomography was performed in a 64-slice
scanner with dipyridamole stress perfusion acquisition before a second perfusion/CT
angiographic acquisition at rest. Independent blinded observers performed analysis
of images from CTP, CTA, and CCA. All 36 patients completed the CT protocol with no
adverse events (mean radiation dose 14.7 ± 3.0 mSv) and with interpretable scans.
CTP results were positive in 27 of 36 patients (75%). From the 9 (25%) disagreements,
6 patients had normal coronary arteries and 2 had no significant stenosis (8 false-positive
results with SPECT, 22%). The remaining patient had an occluded artery with collateral
flow confirmed by conventional coronary angiogram. Good agreement was demonstrated
between CTP and SPECT on a per-patient analysis (kappa 0.53). In 26 patients using
CCA as reference, sensitivity, specificity, and positive and negative predictive values
were 88.0%, 79.3%, 66.7%, and 93.3% for CTP and 68.8, 76.1%, 66.7%, and 77.8%, for
SPECT, respectively (p = NS). In conclusion, dipyridamole CT myocardial perfusion
at rest and during stress is feasible and results are similar to single-photon emission
CT scintigraphy. The anatomical-perfusion information provided by this combined CT
protocol may allow identification of false-positive results by SPECT.
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References
- Quantification of obstructive and nonobstructive coronary lesions by 64-slice computed tomography: a comparative study with quantitative coronary angiography and intravascular ultrasound.J Am Coll Cardiol. 2005; 46: 147-154
- Accuracy of MSCT coronary angiography with 64-slice technology: first experience.Eur Heart J. 2005; 26: 1482-1487
- High-resolution spiral computed tomography coronary angiography in patients referred for diagnostic conventional coronary angiography.Circulation. 2005; 112: 2318-2323
- Diagnostic accuracy of noninvasive coronary angiography using 64-slice spiral computed tomography.J Am Coll Cardiol. 2005; 46: 552-557
- Diagnostic accuracy of non-invasive 64-slice CT coronary angiography in patients with stable angina pectoris.Eur Radiol. 2006; 16: 575-582
- Usefulness of multidetector row spiral computed tomography with 64- × 0.6-mm collimation and 330-ms rotation for the noninvasive detection of significant coronary artery stenoses.Am J Cardiol. 2006; 97: 343-358
- Diagnostic performance of coronary angiography by 64-row CT.N Engl J Med. 2008; 359: 2324-2336
- Coronary CT angiography using 64 detector rows: methods and design of the multi-centre trial CORE-64.Eur Radiol. 2009; 19: 816-828
- Standardized myocardial segmentation and nomenclature for tomographic imaging of the heart: a statement for healthcare professionals from the Cardiac Imaging Committee of the Council on Clinical Cardiology of the American Heart Association.Circulation. 2002; 105: 539-542
- Comprehensive assessment of myocardial perfusion defects, regional wall motion, and left ventricular function by using 64-section multidetector CT.Radiology. 2008; 248: 466-475
- Assessment of patient dose in CT.(Chilton, NRPB-PE/1/2004)2004
- Relationship between CT coronary angiography and stress perfusion imaging in patients with suspected ischemic heart disease assessed by integrated PET-CT imaging.J Nucl Cardiol. 2007; 14: 799-809
- Hybrid PET/CT is greater than the sum of its parts.J Nucl Cardiol. 2008; 15: 118-122
- Adenosine-induced stress myocardial perfusion imaging using dual-source cardiac computed tomography.J Am Coll Cardiol. 2009; 54: 1072-1084
- Multidetector computed tomography myocardial perfusion imaging during adenosine stress.J Am Coll Cardiol. 2006; 48: 153-160
- Adenosine stress 64- and 256-row detector computed tomography angiography and perfusion imaging: a pilot study evaluating the transmural extent of perfusion abnormalities to predict atherosclerosis causing myocardial ischemia.Circ Cardiovasc Imaging. 2009; 2: 174-182
- Estimated radiation dose associated with cardiac CT angiography.JAMA. 2009; 301: 500-507
Article info
Publication history
Accepted:
March 4,
2010
Received in revised form:
March 4,
2010
Received:
November 11,
2009
Footnotes
This work was supported by Grant-in-Aid 2007/56214-8 from the Fundação de Amparo à Pesquisa do Estado de São Paulo, São Paulo/Brazil, and the Zerbini Foundation, São Paulo/Brazil.
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