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.
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.
Authors: Kelley R Branch; Ryan D Haley; Marcio Sommer Bittencourt; Amit R Patel; Edward Hulten; Ron Blankstein Journal: Cardiovasc Diagn Ther Date: 2017-10
Authors: Carlos E Rochitte; Richard T George; Marcus Y Chen; Armin Arbab-Zadeh; Marc Dewey; Julie M Miller; Hiroyuki Niinuma; Kunihiro Yoshioka; Kakuya Kitagawa; Shiro Nakamori; Roger Laham; Andrea L Vavere; Rodrigo J Cerci; Vishal C Mehra; Cesar Nomura; Klaus F Kofoed; Masahiro Jinzaki; Sachio Kuribayashi; Albert de Roos; Michael Laule; Swee Yaw Tan; John Hoe; Narinder Paul; Frank J Rybicki; Jeffery A Brinker; Andrew E Arai; Christopher Cox; Melvin E Clouse; Marcelo F Di Carli; Joao A C Lima Journal: Eur Heart J Date: 2013-11-19 Impact factor: 29.983
Authors: Matthias Rief; Sarah Feger; Peter Martus; Michael Laule; Marc Dewey; Eva Schönenberger Journal: PLoS One Date: 2015-09-01 Impact factor: 3.240