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Updated: May 20, 2026
In Vivo Quantitative Assessment of Myocardial Structure, Function, Perfusion and Viability Using Cardiac Micro-computed Tomography
Published on: February 16, 2016
Quantitative coronary arterial stenosis assessment by multidetector CT and invasive coronary angiography for
G K Godoy1, A Vavere, J M Miller
1Division of Cardiology, Johns Hopkins University, Baltimore, MD, 21287, USA.
Insights
Quantitative CT angiography (QCTA) modestly predicts myocardial perfusion defects, similar to quantitative coronary angiography (QCA). Both methods show limitations in assessing coronary artery disease and perfusion abnormalities.
Area of Science:
- Cardiovascular imaging
- Diagnostic accuracy
- Coronary artery disease
Background:
- Semi-quantitative coronary CT angiography has limited predictive value for stress-induced myocardial perfusion abnormalities.
- The diagnostic performance of quantitative CT angiography (QCTA) for identifying myocardial perfusion defects is not well-established.
Purpose of the Study:
- To assess the accuracy of 64-slice QCTA in detecting significant coronary arterial stenoses (≥50%) compared to quantitative coronary angiography (QCA).
- To evaluate the ability of QCTA and QCA to detect myocardial perfusion abnormalities using SPECT.
Main Methods:
- A multicenter study (CorE-64) enrolled patients referred for cardiac catheterization.
- Quantitative CT angiography (QCTA) and quantitative coronary angiography (QCA) were performed.
- Diagnostic accuracy for detecting myocardial perfusion abnormalities on SPECT was assessed using the area under the receiver-operating-characteristic curve (AUC) in 63 patients.
Main Results:
- QCTA showed an AUC of 0.71 for detecting perfusion abnormalities, compared to 0.72 for QCA (P = .75).
- Optimal QCTA threshold was 43% stenosis (sensitivity 0.81, specificity 0.50), versus 59% for QCA (sensitivity 0.75, specificity 0.69).
- QCTA demonstrated high sensitivity (0.94) and specificity (0.77) for identifying patients with both obstructive lesions and perfusion defects.
Conclusions:
- Both QCTA and QCA provide only modest prediction of myocardial perfusion abnormalities.
- Discrepancies between coronary anatomy and perfusion may be influenced by confounding variables.
Background:
Semi-quantitative stenosis assessment by coronary CT angiography only modestly predicts stress-induced myocardial perfusion abnormalities. The performance of quantitative CT angiography (QCTA) for identifying patients with myocardial perfusion defects remains unclear.
Methods:
CorE-64 is a multicenter, international study to assess the accuracy of 64-slice QCTA for detecting ≥50% coronary arterial stenoses by quantitative coronary angiography (QCA). Patients referred for cardiac catheterization with suspected or known coronary artery disease were enrolled. Area under the receiver-operating-characteristic curve (AUC) was used to evaluate the diagnostic accuracy of the most severe coronary artery stenosis in a subset of 63 patients assessed by QCTA and QCA for detecting myocardial perfusion abnormalities on exercise or pharmacologic stress SPECT.
Results:
Diagnostic accuracy of QCTA for identifying patients with myocardial perfusion abnormalities by SPECT revealed an AUC of 0.71, compared to 0.72 by QCA (P = .75). AUC did not improve after excluding studies with fixed myocardial perfusion abnormalities and total coronary arterial occlusions. Optimal stenosis threshold for QCTA was 43% yielding a sensitivity of 0.81 and specificity of 0.50, respectively, compared to 0.75 and 0.69 by QCA at a threshold of 59%. Sensitivity and specificity of QCTA to identify patients with both obstructive lesions and myocardial perfusion defects were 0.94 and 0.77, respectively.
Conclusions:
Coronary artery stenosis assessment by QCTA or QCA only modestly predicts the presence and the absence of myocardial perfusion abnormalities by SPECT. Confounding variables affecting the relationship between coronary anatomy and myocardial perfusion likely account for some of the observed discrepancies between coronary angiography and SPECT results.
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