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Updated: May 22, 2026
In Vivo Quantitative Assessment of Myocardial Structure, Function, Perfusion and Viability Using Cardiac Micro-computed Tomography
Published on: February 16, 2016
Correlation of myocardial perfusion SPECT with invasive and computed tomography coronary angiogram
S Shelley1, M Indirani, I Sathyamurthy
1Apollo Main Hospitals, Chennai, India.
Insights
Multislice computed tomography (MSCT) effectively detects coronary artery disease (CAD) anatomy, while myocardial perfusion SPECT (MPS) reveals functional ischemia. MSCT shows high negative predictive value for CAD, especially with low calcium scores.
Area of Science:
- Cardiovascular Imaging
- Radiology
- Nuclear Medicine
Background:
- Atherosclerosis consequences are detectable via multislice computed tomography (MSCT), invasive coronary angiogram (CAG), and myocardial perfusion single photon emission computed tomography (MPS).
- Coronary artery disease (CAD) diagnosis relies on various imaging modalities, each with strengths and limitations.
Purpose of the Study:
- To compare MSCT findings with MPS for detecting myocardial ischemia.
- To compare MSCT findings with invasive CAG in patients suspected of CAD.
Main Methods:
- 99 patients with suspected CAD underwent MSCT and MPS using (99m)Tc sestamibi.
- MSCT findings were categorized as no CAD, significant CAD (>50% stenosis), or insignificant CAD (<50% stenosis).
- Invasive CAG was performed on a subgroup of 33 patients.
Main Results:
- MSCT demonstrated a high negative predictive value (NPV) of 97% for CAD.
- When MSCT was normal, MPS was typically normal; however, normal MPS did not always correlate with normal MSCT, which could show insignificant obstructions.
- In the 33-patient subgroup, MSCT correlated well (84%) with invasive CAG, though overestimation occurred in 16% due to high calcium scores (>800).
Conclusions:
- MSCT provides anatomical information, while MPS offers functional insights into myocardial ischemia.
- MSCT is valuable for anatomical assessment, particularly in patients with a low likelihood of CAD and low calcium scores.
- Both modalities are distinct diagnostic tools, with MSCT showing high NPV in specific patient groups.
Background:
The consequences of atherosclerosis can be detected by multislice computed tomography (MSCT), invasive coronary angiogram (CAG) and the resultant myocardial ischaemia by myocardial perfusion single photon emission computed tomography (MPS). In this study an attempt is made to compare MSCT with MPS and also to compare the MSCT findings with that of invasive CAG in patients suspected to have coronary artery disease (CAD).
Materials And Methods:
A total of 99 patients suspected to have CAD underwent both MSCT and MPS with (99m)Tc sestamibi. The MSCT studies were classified as having no CAD, significant CAD (>50% diameter stenosis), and insignificant CAD (<50% diameter stenosis). Myocardial perfusion single photon emission computed tomography was reported as normal and reversible ischaemia. In a subgroup of 33 patient invasive CAG was done.
Results:
In 99 patients, 396 coronaries were evaluated with MSCT and MPS. Coronary artery calcium scoring (CACS) in these patient ranged from 0 to 2200. No CAD was noted in 128 (32%) coronaries but MPS was found abnormal in 9 (7%) coronaries. Insignificant CAD was noted in 169 (43%) coronaries amongst which reversible ischaemia was noted in 23 (14%). Significant CAD was noted in 99 (25%) coronaries of which only 54 (55%) were MPS positive for reversible ischaemia. The MSCT has a negative predictive value (NPV) of 97%. When MSCT was normal, MPS was almost normal, but the reverse was not true. That is when MPS was normal MSCT was not always normal but showed lesion of insignificant obstruction. In the subset of 33 patients, who underwent invasive angiogram, 132 coronaries were evaluated. Coronary angiogram showed 48 coronaries (36%) to have significant CAD (>50% diameter stenosis). Multislice computed tomography correlated well in 46 (84%) with P value of <0.001 (χ(2)-test) but for 9 (16%) showing overestimation due to increased CACS (>800). Myocardial perfusion single photon emission computed tomography was normal in 15 (27%) coronaries.
Conclusion:
Myocardial perfusion single photon emission computed tomography provides functional information of the anatomical lesions and MSCT provides anatomical information. Both are two different diagnostic modalities. The MSCT has high NPV in patients with less likelihood for CAD. When compared with CAG, the correlation with MSCT was good and is useful where the calcium score is low.
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