Nuno Bettencourt1, Nuno Dias Ferreira2, Daniel Leite2, Mónica Carvalho2, Wilson da Silva Ferreira2, Andreas Schuster3, Amedeo Chiribiri4, Adelino Leite-Moreira5, José Silva-Cardoso5, Eike Nagel4, Vasco Gama2. 1. Cardiology Department, Centro Hospitalar de Gaia/Espinho, Vila Nova de Gaia, Portugal; Division of Imaging Sciences and Medical Engineering, King's College London, London, United Kingdom; Cardiovascular R&D Unit, Faculty of Medicine, University of Porto, Porto, Portugal. Electronic address: bettencourt.n@gmail.com. 2. Cardiology Department, Centro Hospitalar de Gaia/Espinho, Vila Nova de Gaia, Portugal. 3. Georg-August-University and German Center for Cardiovascular Research (DZHK, Partner Site), Göttingen, Germany. 4. Division of Imaging Sciences and Medical Engineering, King's College London, London, United Kingdom. 5. Cardiovascular R&D Unit, Faculty of Medicine, University of Porto, Porto, Portugal.
Abstract
OBJECTIVES: This study sought to compare computed tomography delayed enhancement (CTDE) against cardiac magnetic resonance (CMR) late gadolinium enhancement (LGE) for detection of ischemic scar and to test the additive value of CTDE as part of a comprehensive multidetector computed tomography (MDCT) stress-rest protocol including computed tomography perfusion (CTP) and computed tomography angiography (CTA) for the diagnosis of significant coronary artery disease (CAD). BACKGROUND: CTDE has been recently described as a promising tool for noninvasive detection of myocardial scar, similarly to CMR-LGE techniques. Despite its theoretical potential as an adjunctive tool to improve MDCT accuracy for detection of CAD, its clinical performance has not been validated. METHODS: One hundred five symptomatic patients with suspected CAD (age 62.0 ± 8.0 years, 67% men) underwent MDCT, CMR, and x-ray invasive coronary angiography. The MDCT protocol consisted of calcium scoring, stress CTP under adenosine 140 μg/kg/min, rest CTP + CTA, and a low-dose radiation prospective scan for detection of CTDE. CMR-LGE was used as the reference standard for assessment of scar. Functionally significant CAD was defined as the presence of ≥90% stenosis/occlusion or fractional flow reserve measurements ≤0.80 in vessels >2 mm. RESULTS: CTDE had good accuracy (90%) for ischemic scar detection with low sensitivity (53%) but excellent specificity (98%). Positive and negative predictive values were 82% and 91%, respectively. On a patient-based model, MDCT protocol without integration of CTDE results had a sensitivity, specificity, and positive and negative predictive values of 90%, 81%, 80%, and 90%, respectively, for the detection of functionally significant CAD. Addition of CTDE results did not improve MDCT performance (90%, 77%, 77%, and 90%, respectively). CONCLUSIONS: CTDE has moderate accuracy for detection of ischemic scar in patients with suspected CAD. Integration of CTDE into a comprehensive MDCT protocol including stress-rest CTP and CTA does not improve MDCT accuracy for detection of significant CAD in intermediate-to-high pre-test probability populations.
OBJECTIVES: This study sought to compare computed tomography delayed enhancement (CTDE) against cardiac magnetic resonance (CMR) late gadolinium enhancement (LGE) for detection of ischemic scar and to test the additive value of CTDE as part of a comprehensive multidetector computed tomography (MDCT) stress-rest protocol including computed tomography perfusion (CTP) and computed tomography angiography (CTA) for the diagnosis of significant coronary artery disease (CAD). BACKGROUND:CTDE has been recently described as a promising tool for noninvasive detection of myocardial scar, similarly to CMR-LGE techniques. Despite its theoretical potential as an adjunctive tool to improve MDCT accuracy for detection of CAD, its clinical performance has not been validated. METHODS: One hundred five symptomatic patients with suspected CAD (age 62.0 ± 8.0 years, 67% men) underwent MDCT, CMR, and x-ray invasive coronary angiography. The MDCT protocol consisted of calcium scoring, stress CTP under adenosine 140 μg/kg/min, rest CTP + CTA, and a low-dose radiation prospective scan for detection of CTDE. CMR-LGE was used as the reference standard for assessment of scar. Functionally significant CAD was defined as the presence of ≥90% stenosis/occlusion or fractional flow reserve measurements ≤0.80 in vessels >2 mm. RESULTS:CTDE had good accuracy (90%) for ischemic scar detection with low sensitivity (53%) but excellent specificity (98%). Positive and negative predictive values were 82% and 91%, respectively. On a patient-based model, MDCT protocol without integration of CTDE results had a sensitivity, specificity, and positive and negative predictive values of 90%, 81%, 80%, and 90%, respectively, for the detection of functionally significant CAD. Addition of CTDE results did not improve MDCT performance (90%, 77%, 77%, and 90%, respectively). CONCLUSIONS:CTDE has moderate accuracy for detection of ischemic scar in patients with suspected CAD. Integration of CTDE into a comprehensive MDCT protocol including stress-rest CTP and CTA does not improve MDCT accuracy for detection of significant CAD in intermediate-to-high pre-test probability populations.
Authors: Christoph Langer; M Both; H Harders; M Lutz; M Eden; C Kühl; B Sattler; O Jansen; P Schaefer; N Frey Journal: Eur Radiol Date: 2014-10-15 Impact factor: 5.315
Authors: A M Bucher; C N De Cecco; U J Schoepf; R Wang; F G Meinel; S R Binukrishnan; J V Spearman; T J Vogl; B Ruzsics Journal: Br J Radiol Date: 2014-08-19 Impact factor: 3.039
Authors: C Langer; M Lutz; M Eden; M Lüdde; M Hohnhorst; C Gierloff; M Both; W Burchert; L Faber; D Horstkotte; N Frey; C Prinz Journal: Int J Cardiovasc Imaging Date: 2014-01-22 Impact factor: 2.357
Authors: Filippo Cademartiri; Sara Seitun; Alberto Clemente; Ludovico La Grutta; Patrizia Toia; Giuseppe Runza; Massimo Midiri; Erica Maffei Journal: Cardiovasc Diagn Ther Date: 2017-04
Authors: Jorge A Gonzalez; Michael J Lipinski; Lucia Flors; Peter W Shaw; Christopher M Kramer; Michael Salerno Journal: Am J Cardiol Date: 2015-08-14 Impact factor: 2.778