nach oben

Erschienen in:

01.07.2013 | Cardiac

Diagnostic accuracy of combined coronary angiography and adenosine stress myocardial perfusion imaging using 320-detector computed tomography: pilot study

verfasst von: Arthur Nasis, Brian S. Ko, Michael C. Leung, Paul R. Antonis, Dee Nandurkar, Dennis T. Wong, Leo Kyi, James D. Cameron, John M. Troupis, Ian T. Meredith, Sujith K. Seneviratne

Erschienen in: European Radiology | Ausgabe 7/2013

Einloggen, um Zugang zu erhalten

Abstract

Objectives

To determine the diagnostic accuracy of combined 320-detector row computed tomography coronary angiography (CTA) and adenosine stress CT myocardial perfusion imaging (CTP) in detecting perfusion abnormalities caused by obstructive coronary artery disease (CAD).

Methods

Twenty patients with suspected CAD who underwent initial investigation with single-photon-emission computed tomography myocardial perfusion imaging (SPECT-MPI) were recruited and underwent prospectively-gated 320-detector CTA/CTP and invasive angiography. Two blinded cardiologists evaluated invasive angiography images quantitatively (QCA). A blinded nuclear physician analysed SPECT-MPI images for fixed and reversible perfusion defects. Two blinded cardiologists assessed CTA/CTP studies qualitatively. Vessels/territories with both >50 % stenosis on QCA and corresponding perfusion defect on SPECT-MPI were defined as ischaemic and formed the reference standard.

Results

All patients completed the CTA/CTP protocol with diagnostic image quality. Of 60 vessels/territories, 17 (28 %) were ischaemic according to QCA/SPECT-MPI criteria. Sensitivity, specificity, PPV, NPV and area under the ROC curve for CTA/CTP was 94 %, 98 %, 94 %, 98 % and 0.96 (P < 0.001) on a per-vessel/territory basis. Mean CTA/CTP radiation dose was 9.2 ± 7.4 mSv compared with 13.2 ± 2.2 mSv for SPECT-MPI (P < 0.001).

Conclusions

Combined 320-detector CTA/CTP is accurate in identifying obstructive CAD causing perfusion abnormalities compared with combined QCA/SPECT-MPI, achieved with lower radiation dose than SPECT-MPI.

Key Points

• Advances in CT technology provides comprehensive anatomical and functional cardiac information.

• Combined 320-detector CTA/adenosine-stress CTP is feasible with excellent image quality.

• Combined CTA/CTP is accurate in identifying myocardial ischaemia compared with QCA/SPECT-MPI.

• Combined CTA/CTP results in lower patient radiation exposure than SPECT-MPI.

• CTA/CTP may become an established imaging technique for suspected CAD.

Beller G, Zaret B (2000) Contributions of nuclear cardiology to diagnosis and prognosis of patients with coronary artery disease. Circulation 101:1465–1478PubMedCrossRef

Shaw L, Iskandrian A (2004) Prognostic value of gated myocardial perfusion SPECT. J Nucl Cardiol 11:171–185PubMedCrossRef

Davies R, Goldberg A, Forman S et al (1997) Asymptomatic Cardiac Ischemia Pilot (ACIP) study two-year follow-up: outcomes of patients randomized to initial strategies of medical therapy versus revascularization. Circulation 95:2037–2043PubMedCrossRef

Erne P, Schoenenberger A, Burckhardt D et al (2007) Effects of percutaneous coronary interventions in silent ischemia after myocardial infarction: the SWISSI II randomized controlled trial. JAMA 297:1985–1991PubMedCrossRef

Hachamovitch R, Hayes S, Friedman J et al (2003) Comparison of the short-term survival benefit associated with revascularization compared with medical therapy in patients with no prior coronary artery disease undergoing stress myocardial perfusion single photon emission computed tomography. Circulation 107:2900–2907PubMedCrossRef

Shaw L, Berman D, Maron D et al (2008) Optimal medical therapy with or without percutaneous coronary intervention to reduce ischemic burden: results from the Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation (COURAGE) trial nuclear substudy. Circulation 117:1283–1291PubMedCrossRef

Schuhbäck A, Marwan M, Gauss S et al (2012) Interobserver agreement for the detection of atherosclerotic plaque in coronary CT angiography: comparison of two low-dose image acquisition protocols with standard retrospectively ECG-gated reconstruction. Eur Radiol 22:1529–1536PubMedCrossRef

Budoff M, Dowe D, Jollis J et al (2008) Diagnostic performance of 64-multidetector row coronary computed tomographic angiography for evaluation of coronary artery stenosis in individuals without known coronary artery disease: results from the prospective multicenter ACCURACY (Assessment by Coronary Computed Tomographic Angiography of Individuals Undergoing Invasive Coronary Angiography) trial. J Am Coll Cardiol 52:1724–1732PubMedCrossRef

Dewey M, Zimmermann E, Deissenrieder F et al (2009) Noninvasive coronary angiography by 320-row computed tomography with lower radiation exposure and maintained diagnostic accuracy: comparison of results with cardiac catheterization in a head-to-head pilot investigation. Circulation 120:867–875PubMedCrossRef

10.

Neefjes L, Rossi A, Genders T et al (2012) Diagnostic accuracy of 128-slice dual-source CT coronary angiography: a randomized comparison of different acquisition protocols. Eur Radiol 23:614-622

11.

Rispler S, Keidar Z, Ghersin E et al (2007) Integrated single-photon emission computed tomography and computed tomography coronary angiography for the assessment of hemodynamically significant coronary artery lesions. J Am Coll Cardiol 49:1059–1067PubMedCrossRef

12.

Hacker M, Jakobs T, Hack N et al (2007) Sixty-four slice spiral CT angiography does not predict the functional relevance of coronary artery stenoses in patients with stable angina. Eur J Nucl Med Mol Imaging 34:4–10PubMedCrossRef

13.

Ko B, Cameron J, Meredith I et al (2012) Computed tomography stress myocardial perfusion imaging in patients considered for revascularization: a comparison with fractional flow reserve. Eur Heart J 33:67–77PubMedCrossRef

14.

Gervaise A, Osemont B, Lecocq S et al (2012) CT image quality improvement using adaptive iterative dose reduction with wide-volume acquisition on 320-detector CT. Eur Radiol 22:295–301PubMedCrossRef

15.

Blankstein R, Shturman L, Rogers I et al (2009) Adenosine-induced stress myocardial perfusion imaging using dual-source cardiac computed tomography. J Am Coll Cardiol 54:1072–1084PubMedCrossRef

16.

George R, Arbab-Zadeh A, Miller J et al (2009) 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 2:174–182PubMedCrossRef

17.

Okada D, Ghoshhajra B, Blankstein R et al (2010) Direct comparison of rest and adenosine stress myocardial perfusion CT with rest and stress SPECT. J Nucl Cardiol 17:27–37PubMedCrossRef

18.

Rocha-Filho J, Blankstein R, Shturman L et al (2010) Incremental value of adenosine-induced stress myocardial perfusion imaging with dual-source CT at cardiac CT angiography. Radiology 254:410–419PubMedCrossRef

19.

Mehra V, Valdiviezo C, Arbab-Zadeh A et al (2011) A stepwise approach to the visual interpretation of CT-based myocardial perfusion. J Cardiovasc Comput Tomogr 5:357–369PubMedCrossRef

20.

Austen W, Edwards J, Frye R et al (1975) A reporting system on patients evaluated for coronary artery disease. Report of the Ad Hoc Committee for Grading of Coronary Artery Disease, Council on Cardiovascular Surgery. Circulation 51:5–40PubMedCrossRef

21.

Cerqueira M, Weissman N, Dilsizian V et al (2002) 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 105:539–542PubMedCrossRef

22.

Shrimpton P, Hillier M, Lewis M, Dunn M (2006) National survey of doses from CT in the UK: 2003. Br J Radiol 79:968–980PubMedCrossRef

23.

Newcombe R (1998) Two-sided confidence intervals for the single proportion: comparison of seven methods. Stat Med 17:857–872PubMedCrossRef

24.

Zweig M, Campbell G (1993) Receiver-operating characteristic (ROC) plots: a fundamental evaluation tool in clinical medicine. Clin Chem 39:561–577PubMed

25.

DeLong E, DeLong D, Clarke-Pearson D (1988) Comparing the areas under two or more correlated receiver operating characteristic curves: a nonparametric approach. Biometrics 44:837–845PubMedCrossRef

26.

Pencina M, D’Agostino R Sr, D’Agostino R Jr, Vasan R (2008) Evaluating the added predictive ability of a new marker: from area under the ROC curve to reclassification and beyond. Stat Med 27:157–172, discussion 207–12PubMedCrossRef

27.

George R, Arbab-Zadeh A, Miller J et al (2012) Computed tomography myocardial perfusion imaging with 320-row detector computed tomography accurately detects myocardial ischemia in patients with obstructive coronary artery disease. Circ Cardiovasc Imaging 5:333–340PubMedCrossRef

28.

Bamberg F, Becker A, Schwarz F et al (2011) Detection of hemodynamically significant coronary artery stenosis: incremental diagnostic value of dynamic CT-based myocardial perfusion imaging. Radiology 260:689–698PubMedCrossRef

29.

Bastarrika G, Ramos-Duran L, Rosenblum M, Kang D, Rowe G, Schoepf U (2010) Adenosine-stress dynamic myocardial CT perfusion imaging: initial clinical experience. Invest Radiol 45:306–313PubMedCrossRef

30.

Feuchtner G, Goetti R, Plass A et al (2011) Adenosine stress high-pitch 128-slice dual-source myocardial computed tomography perfusion for imaging of reversible myocardial ischemia: comparison with magnetic resonance imaging. Circ Cardiovasc Imaging 4:540–549PubMedCrossRef

31.

Garcia E, Faber T, Esteves F (2011) Cardiac dedicated ultrafast SPECT cameras: new designs and clinical implications. J Nucl Med 52:210–217PubMedCrossRef

32.

Taylor A, Cerqueira M, Hodgson J et al (2010) ACCF/SCCT/ACR/AHA/ASE/ASNC/NASCI/SCAI/SCMR 2010 Appropriate use criteria for Cardiac Computed Tomography. A Report of the American College of Cardiology Foundation Appropriate Use Criteria Task Force, the Society of Cardiovascular Computed Tomography, the American College of Radiology, the American Heart Association, the American Society of Echocardiography, the American Society of Nuclear Cardiology, the North American Society for Cardiovascular Imaging, the Society for Cardiovascular Angiography and Interventions, and the Society for Cardiovascular Magnetic Resonance. J Cardiovasc Comput Tomogr 4:e1–e33PubMedCrossRef

33.

Techasith T, Cury R (2011) Stress myocardial CT perfusion: an update and future perspective. JACC Cardiovasc Imaging 4:905–916PubMedCrossRef

34.

Tonino P, Fearon W, De Bruyne B et al (2010) Angiographic versus functional severity of coronary artery stenoses in the FAME study fractional flow reserve versus angiography in multivessel evaluation. J Am Coll Cardiol 55:2816–2821PubMedCrossRef

35.

Jung P, Rieber J, Stork S et al (2008) Effect of contrast application on interpretability and diagnostic value of dobutamine stress echocardiography in patients with intermediate coronary lesions: comparison with myocardial fractional flow reserve. Eur Heart J 29:2536–2543PubMedCrossRef

36.

Gaemperli O, Husmann L, Schepis T et al (2009) Coronary CT angiography and myocardial perfusion imaging to detect flow-limiting stenoses: a potential gatekeeper for coronary revascularization? Eur Heart J 30:2921–2929PubMedCrossRef

37.

Min J, Leipsic J, Pencina M et al (2012) Diagnostic accuracy of fractional flow reserve from anatomic CT angiography. JAMA 308:1237–1245PubMed

38.

Vavere A, Simon G, George R et al (2011) Diagnostic performance of combined noninvasive coronary angiography and myocardial perfusion imaging using 320 row detector computed tomography: design and implementation of the CORE320 multicenter, multinational diagnostic study. J Cardiovasc Comput Tomogr 5:370–381PubMedCrossRef

39.

Bottcher M, Refsgaard J, Madsen M et al (2003) Effect of antianginal medication on resting myocardial perfusion and pharmacologically induced hyperemia. J Nucl Cardiol 10:345–352PubMedCrossRef

40.

Zoghbi G, Dorfman T, Iskandrian A (2008) The effects of medications on myocardial perfusion. J Am Coll Cardiol 52:401–416PubMedCrossRef

41.

Koepfli P, Wyss C, Namdar M et al (2004) Beta-adrenergic blockade and myocardial perfusion in coronary artery disease: differential effects in stenotic versus remote myocardial segments. J Nucl Med 45:1626–1631PubMed

Titel: Diagnostic accuracy of combined coronary angiography and adenosine stress myocardial perfusion imaging using 320-detector computed tomography: pilot study
verfasst von: Arthur Nasis
Brian S. Ko
Michael C. Leung
Paul R. Antonis
Dee Nandurkar
Dennis T. Wong
Leo Kyi
James D. Cameron
John M. Troupis
Ian T. Meredith
Sujith K. Seneviratne
Publikationsdatum: 01.07.2013
Verlag: Springer-Verlag
Erschienen in: European Radiology / Ausgabe 7/2013
Print ISSN: 0938-7994
Elektronische ISSN: 1432-1084
DOI: https://doi.org/10.1007/s00330-013-2788-z

Neu im Fachgebiet Radiologie

23.04.2024 | Pankreaskarzinom | Nachrichten

Update Radiologie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen

Springer Medizin

Diagnostic accuracy of combined coronary angiography and adenosine stress myocardial perfusion imaging using 320-detector computed tomography: pilot study

Abstract

Objectives

Methods

Results

Conclusions

Key Points

Neu im Fachgebiet Radiologie

S3-Leitlinie zu Pankreaskrebs aktualisiert

Fünf Dinge, die im Kindernotfall besser zu unterlassen sind

„Nur wer sich gut aufgehoben fühlt, kann auch für Patientensicherheit sorgen“

Wie toxische Männlichkeit der Gesundheit von Männern schadet

Update Radiologie

Springer Medizin

Abstract

Objectives

Methods

Results

Conclusions

Key Points

Bitte loggen Sie sich ein, um Zugang zu diesem Inhalt zu erhalten

Weitere Artikel der Ausgabe 7/2013

Ten-year experience of percutaneous image-guided radiofrequency ablation of malignant renal tumours in high-risk patients

Combined contrast-enhanced magnetic resonance and diffusion-weighted imaging reading adapted to the “Breast Imaging Reporting and Data System” for multiparametric 3-T imaging of breast lesions

Triphasic CT in the diagnosis of acute mesenteric ischaemia

Erratum to: Evaluation of liver fat in the presence of iron with MRI using T2* correction: a clinical approach

MR relaxometry and perfusion of the myocardium in spontaneously hypertensive rat: correlation with histopathology and effect of anti-hypertensive therapy

Characterisation of carotid plaques with ultrasound elastography: feasibility and correlation with high-resolution magnetic resonance imaging

Neu im Fachgebiet Radiologie

S3-Leitlinie zu Pankreaskrebs aktualisiert

Fünf Dinge, die im Kindernotfall besser zu unterlassen sind

„Nur wer sich gut aufgehoben fühlt, kann auch für Patientensicherheit sorgen“

Wie toxische Männlichkeit der Gesundheit von Männern schadet

Update Radiologie