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Published on: February 16, 2016
Myocardial Perfusion by Coronary Computed Tomography in the Evaluation of Myocardial Ischemia: Simultaneous Stress
Wilter Dos Santos Ker1,2, Daniel Gama das Neves2, Tiago Augusto Magalhães3
1Hospital Universitário Antonio Pedro, Niterói, RJ - Brazil.
Insights
Coronary computed tomography angiography (CCTA) shows good performance in detecting obstructive coronary artery disease (CAD), outperforming SPECT. CCTA can help rule out false positives in myocardial perfusion imaging.
Area of Science:
- Cardiology
- Radiology
- Medical Imaging
Background:
- Functional assessment for myocardial ischemia using coronary computed tomography angiography (CCTA) is crucial.
- Limited data exists on CCTA's performance in the Brazilian population.
Purpose of the Study:
- To evaluate the diagnostic accuracy of CCTA-based myocardial perfusion imaging for detecting severe obstructive coronary artery disease (CAD).
- To compare CCTA's performance against single-photon emission computerized tomography (SPECT).
- To analyze the role of anatomical knowledge in interpreting SPECT perfusion defects not seen on CT.
Main Methods:
- 35 patients underwent simultaneous pharmacologic stress protocols.
- Fisher's exact test and ROC curve analysis were used to compare diagnostic performance.
- Patients were grouped based on the presence or absence of significant CAD.
Main Results:
- CCTA myocardial perfusion analysis demonstrated a high area under the ROC curve (AUC) of 0.84 for detecting obstructive CAD.
- SPECT myocardial perfusion imaging had a significantly lower AUC of 0.58.
- The study identified false-positive results associated with SPECT imaging.
Conclusions:
- Myocardial perfusion analysis by CCTA is effective in detecting obstructive CAD, showing satisfactory results compared to SPECT.
- CCTA has the potential to identify and rule out false-positive findings from SPECT imaging.
Background:
Functional assessment to rule out myocardial ischemia using coronary computed tomography angiography (CCTA) is extremely important and data on the Brazilian population are still limited.
Objective:
To assess the diagnostic performance of myocardial perfusion by CCTA in the detection of severe obstructive coronary artery disease (CAD) compared with single-photon emission computerized tomography (SPECT). To analyze the importance of anatomical knowledge to understand the presence of myocardial perfusion defects on SPECT imaging that is not identified on computed tomography (CT) scan.
Method:
A total of 35 patients were evaluated by a simultaneous pharmacologic stress protocol. Fisher's exact test was used to compare proportions. The patients were grouped according to the presence or absence of significant CAD. The area under the ROC curve was used to identify the diagnostic performance of CCTA and SPECT in perfusion assessment. P < 0.05 values were considered statistically significant.
Results:
For detection of obstructive CAD, CT myocardial perfusion analysis yielded an area under the ROC curve of 0.84 [a 95% confidence interval (CI95%): 0.67-0.94, p < 0.001]. SPECT myocardial perfusion imaging, on the other hand, showed an AUC of 0.58 (95% CI 0.40 - 0.74, p < 0.001). In this study, false-positive results with SPECT are described.
Conclusion:
Myocardial perfusion analysis by CTA displays satisfactory results compared to SPECT in the detection of obstructive CAD. CCTA can rule out false-positive results of SPECT.
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