OBJECTIVE: Coronary CT angiography has high sensitivity, but modest specificity, to detect acute coronary syndrome. We studied whether adding resting CT myocardial perfusion imaging improved the detection of acute coronary syndrome. SUBJECTS AND METHODS: Patients with low-to-intermediate cardiac risk presenting with possible acute coronary syndrome received both the standard of care evaluation and a research thoracic 64-MDCT examination. Patients with an obstructive (> 50%) stenosis or a nonevaluable coronary segment on CT were diagnosed with possible acute coronary syndrome. CT perfusion was determined by applying gray and color Hounsfield unit maps to resting CT angiography images. Adjudicated patient diagnoses were based on the standard of care and 3-month follow-up. Patient-level diagnostic performance for acute coronary syndrome was calculated for coronary CT, CT perfusion, and combined techniques. RESULTS: A total of 105 patients were enrolled. Of the nine (9%) patients with acute coronary syndrome, all had obstructive CT stenoses but only three had abnormal CT perfusion. CT perfusion was normal in all other patients. To detect acute coronary syndrome, CT angiography had 100% sensitivity, 89% specificity, and a positive predictive value of 45%. For CT perfusion, specificity and positive predictive value were each 100%, and sensitivity was 33%. Combined cardiac CT and CT perfusion had similar specificity but a higher positive predictive value (100%) than did CT angiography. CONCLUSION: Resting CT perfusion using CT angiographic images may have high specificity and may improve CT positive predictive value for acute coronary syndrome without added radiation and contrast. However, normal resting CT perfusion cannot exclude acute coronary syndrome.
OBJECTIVE: Coronary CT angiography has high sensitivity, but modest specificity, to detect acute coronary syndrome. We studied whether adding resting CT myocardial perfusion imaging improved the detection of acute coronary syndrome. SUBJECTS AND METHODS: Patients with low-to-intermediate cardiac risk presenting with possible acute coronary syndrome received both the standard of care evaluation and a research thoracic 64-MDCT examination. Patients with an obstructive (> 50%) stenosis or a nonevaluable coronary segment on CT were diagnosed with possible acute coronary syndrome. CT perfusion was determined by applying gray and color Hounsfield unit maps to resting CT angiography images. Adjudicated patient diagnoses were based on the standard of care and 3-month follow-up. Patient-level diagnostic performance for acute coronary syndrome was calculated for coronary CT, CT perfusion, and combined techniques. RESULTS: A total of 105 patients were enrolled. Of the nine (9%) patients with acute coronary syndrome, all had obstructive CT stenoses but only three had abnormal CT perfusion. CT perfusion was normal in all other patients. To detect acute coronary syndrome, CT angiography had 100% sensitivity, 89% specificity, and a positive predictive value of 45%. For CT perfusion, specificity and positive predictive value were each 100%, and sensitivity was 33%. Combined cardiac CT and CT perfusion had similar specificity but a higher positive predictive value (100%) than did CT angiography. CONCLUSION: Resting CT perfusion using CT angiographic images may have high specificity and may improve CT positive predictive value for acute coronary syndrome without added radiation and contrast. However, normal resting CT perfusion cannot exclude acute coronary syndrome.
Authors: Manuel D Cerqueira; Neil J Weissman; Vasken Dilsizian; Alice K Jacobs; Sanjiv Kaul; Warren K Laskey; Dudley J Pennell; John A Rumberger; Thomas Ryan; Mario S Verani Journal: Circulation Date: 2002-01-29 Impact factor: 29.690
Authors: Joshua L Busch; Adam M Alessio; James H Caldwell; Mohit Gupta; Songshou Mao; Jigar Kadakia; William Shuman; Matthew J Budoff; Kelley R Branch Journal: J Cardiovasc Comput Tomogr Date: 2011-10-24
Authors: Andreas H Mahnken; Ralf Koos; Marcus Katoh; Joachim E Wildberger; Elmar Spuentrup; Arno Buecker; Rolf W Günther; Harald P Kühl Journal: J Am Coll Cardiol Date: 2005-06-21 Impact factor: 24.094
Authors: L I Heller; C Cates; J Popma; L I Deckelbaum; J D Joye; S T Dahlberg; B J Villegas; A Arnold; R Kipperman; W C Grinstead; S Balcom; Y Ma; M Cleman; R M Steingart; J A Leppo Journal: Circulation Date: 1997-07-15 Impact factor: 29.690
Authors: G V Heller; S A Stowers; R C Hendel; S D Herman; E Daher; A W Ahlberg; J M Baron; C F Mendes de Leon; J A Rizzo; F J Wackers Journal: J Am Coll Cardiol Date: 1998-04 Impact factor: 24.094
Authors: M M Henneman; J D Schuijf; J W Jukema; H J Lamb; A de Roos; P Dibbets; M P Stokkel; E E van der Wall; J J Bax Journal: Heart Date: 2006-06-01 Impact factor: 5.994
Authors: Amit Pursnani; Ashley M Lee; Thomas Mayrhofer; Waleed Ahmed; Shanmugam Uthamalingam; Maros Ferencik; Stefan B Puchner; Fabian Bamberg; Christopher L Schlett; James Udelson; Udo Hoffmann; Brian B Ghoshhajra Journal: Circ Cardiovasc Imaging Date: 2015-03 Impact factor: 7.792
Authors: Robbert W van Hamersvelt; Majd Zreik; Michiel Voskuil; Max A Viergever; Ivana Išgum; Tim Leiner Journal: Eur Radiol Date: 2018-11-12 Impact factor: 5.315
Authors: Kelley R Branch; Jared Strote; William P Shuman; Lee M Mitsumori; Janet M Busey; Tessa Rue; James H Caldwell Journal: PLoS One Date: 2013-04-16 Impact factor: 3.240