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Published on: February 10, 2012
Incremental diagnostic value of whole-heart dynamic computed tomography perfusion imaging for detecting obstructive
Hikaru Nishiyama1, Yuki Tanabe1, Teruhito Kido1
1Department of Radiology, Ehime University Graduate School of Medicine, Shitsukawa, Toon City, Ehime, Japan.
Insights
Dynamic myocardial CT perfusion (CTP) imaging improves the detection of obstructive coronary artery disease (CAD) when combined with CT angiography (CTA). This integrated approach offers superior diagnostic performance compared to CTA alone for patients with a high likelihood of CAD.
Area of Science:
- Cardiology
- Radiology
- Medical Imaging
Background:
- Coronary artery disease (CAD) diagnosis relies on accurate imaging.
- Coronary CT angiography (CTA) is a primary non-invasive tool.
- Evaluating the added value of CT perfusion (CTP) can refine diagnostic strategies.
Purpose of the Study:
- To assess the incremental diagnostic value of dynamic myocardial CT perfusion (CTP) imaging.
- To compare the diagnostic performance of CTP combined with CTA against CTA alone.
- To detect obstructive coronary artery disease (CAD).
Main Methods:
- Retrospective analysis of 38 patients undergoing CTA, stress dynamic CTP, and invasive coronary angiography (ICA).
- Obstructive CAD defined by ICA and fractional flow reserve (FFR <0.75).
- Quantitative analysis of CT-derived myocardial blood flow (CT-MBF) and ROC curve analysis for CT-MBF cut-off determination.
Main Results:
- Integrated CTA and CTP demonstrated higher diagnostic performance than CTA alone (AUC 0.96 vs. 0.84).
- CTP significantly improved specificity for detecting obstructive CAD, especially when using a 70% stenosis threshold on CTA (97% vs. 69%).
- The optimal CT-MBF cut-off for obstructive CAD was determined to be 1.26mL/g/min.
Conclusions:
- Dynamic myocardial CTP is feasible for detecting hemodynamically obstructive CAD.
- Integrating CTP with CTA enhances diagnostic accuracy in patients with high pre-test likelihood of CAD.
- This combined approach offers improved diagnostic performance over CTA alone.
Background:
This study aimed to evaluate the incremental diagnostic value of dynamic myocardial computed tomography (CT) perfusion (CTP) imaging for detecting obstructive coronary artery disease (CAD) in comparison with coronary CT angiography (CTA).
Methods:
Thirty-eight patients who had undergone coronary CTA and pharmacological stress dynamic CTP before invasive coronary angiography (ICA) were selected retrospectively. Using ICA, obstructive CAD was defined as the presence of severe (≥70%) or moderate (50-69%) stenosis with fractional flow reserve (FFR) <0.75. For CT evaluations, coronary vessels with any stenosis ≥50%, ≥70% or unassessable lesions were considered significantly stenotic. Dynamic CTP was assessed quantitatively using CT-derived myocardial blood flow (CT-MBF). Receiver operating characteristic (ROC) curve analysis determined the cut-off value of CT-MBF for identifying obstructive CAD. The diagnostic performances of CTA alone and integrated CTA and CTP assessments for detecting obstructive CAD were compared.
Results:
Using ICA and FFR, 24 of 114 vessels had obstructive CAD. The cut-off value of CT-MBF for detecting obstructive CAD was 1.26mL/g/min. The sensitivity, specificity, and positive and negative predictive values (PPV and NPV) at the vessel level were 96%, 57%, 37%, and 98% for CTA, and 83%, 93%, 77%, and 95% for integrated CTA and CTP assessment using cut-off 50% stenosis on CTA, respectively. The sensitivity, specificity, and PPV and NPV at the vessel level were 79%, 69%, 40%, and 93% for CTA, and 71%, 97%, 85%, and 93% for integrated CTA and CTP assessment using cut-off 70% stenosis on CTA, respectively. The area under the ROC curve for CTA and CTP was significantly higher than that for CTA alone (0.96 vs. 0.84, p<0.05).
Conclusions:
Stress dynamic myocardial CTP is feasible to detect hemodynamically obstructive CAD in patients with high pre-test likelihood and helps for improving diagnostic performance in comparison with coronary CTA alone.
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