Kazuhiro Osawa1, Toru Miyoshi2, Yasushi Koyama3, Katsushi Hashimoto1, Shuhei Sato4, Kazufumi Nakamura1, Nobuhiro Nishii1, Kunihisa Kohno1, Hiroshi Morita2, Susumu Kanazawa4, Hiroshi Ito1. 1. Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan. 2. Department of Cardiovascular Therapeutics, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan. 3. Cardiovascular Center, Sakurabashi-Watanabe Hospital, Umeda, Osaka, Japan. 4. Department of Radiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan.
Abstract
OBJECTIVE: Multi-detector coronary CT angiography (CCTA) can detect coronary stenosis, but it has a limited ability to evaluate myocardial perfusion. We evaluated the usefulness of first-pass CT-myocardial perfusion imaging (MPI) in combination with CCTA for diagnosing coronary artery disease (CAD). METHODS: A total of 145 patients with suspected CAD were enrolled. We used 64-row multi-detector CT (Definition Flash, Siemens). The same coronary CCTA data were used for first-pass CT-MPI without drug loading. Images were reconstructed by examining the signal densities at diastole as colour maps. Diagnostic accuracy was assessed by comparison with invasive coronary angiography. RESULTS: First-pass CT-MPI in combination with CCTA significantly improved diagnostic performance compared with CCTA alone. With per-vessel analysis, the sensitivity, specificity, positive predictive value and negative predictive value increased from 81% to 85%, 87% to 94%, 63% to 79% and 95% to 96%, respectively. The area under the receiver operating characteristic curve for detecting CAD also increased from 0.84 to 0.89 (p=0.02). First-pass CT-MPI was particularly useful for assessing segments that could not be directly evaluated due to severe calcification and motion artefacts. CONCLUSIONS: First-pass CT-MPI has an additional diagnostic value for detecting coronary stenosis, in particular in patients with severe calcification. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
OBJECTIVE: Multi-detector coronary CT angiography (CCTA) can detect coronary stenosis, but it has a limited ability to evaluate myocardial perfusion. We evaluated the usefulness of first-pass CT-myocardial perfusion imaging (MPI) in combination with CCTA for diagnosing coronary artery disease (CAD). METHODS: A total of 145 patients with suspected CAD were enrolled. We used 64-row multi-detector CT (Definition Flash, Siemens). The same coronary CCTA data were used for first-pass CT-MPI without drug loading. Images were reconstructed by examining the signal densities at diastole as colour maps. Diagnostic accuracy was assessed by comparison with invasive coronary angiography. RESULTS: First-pass CT-MPI in combination with CCTA significantly improved diagnostic performance compared with CCTA alone. With per-vessel analysis, the sensitivity, specificity, positive predictive value and negative predictive value increased from 81% to 85%, 87% to 94%, 63% to 79% and 95% to 96%, respectively. The area under the receiver operating characteristic curve for detecting CAD also increased from 0.84 to 0.89 (p=0.02). First-pass CT-MPI was particularly useful for assessing segments that could not be directly evaluated due to severe calcification and motion artefacts. CONCLUSIONS: First-pass CT-MPI has an additional diagnostic value for detecting coronary stenosis, in particular in patients with severe calcification. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
Authors: Gianluca Pontone; Giuseppe Muscogiuri; Daniele Andreini; Andrea I Guaricci; Marco Guglielmo; Saima Mushtaq; Andrea Baggiano; Edoardo Conte; Virginia Beltrama; Andrea Annoni; Alberto Formenti; Elisabetta Mancini; Mark G Rabbat; Mauro Pepi Journal: Curr Treat Options Cardiovasc Med Date: 2016-12
Authors: Song Soo Kim; Sung Min Ko; Sang Il Choi; Bo Hwa Choi; Arthur E Stillman Journal: Int J Cardiovasc Imaging Date: 2016-05-02 Impact factor: 2.357