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Dynamic Myocardial Perfusion CT for the Detection of Hemodynamically Significant Coronary Artery Disease
Fay M A Nous1, Tobias Geisler2, Mariusz B P Kruk3
1Department of Radiology and Nuclear Medicine, Erasmus University Medical Center, University Medical Center Rotterdam, Rotterdam, the Netherlands; Department of Cardiology, Erasmus University Medical Center, University Medical Center Rotterdam, Rotterdam, the Netherlands.
Insights
Dynamic stress CT myocardial perfusion imaging (CT-MPI) combined with coronary CT angiography (CTA) improves the diagnosis of significant coronary artery disease compared to CTA alone. This multicenter study supports its broader clinical use for identifying inducible myocardial ischemia.
Area of Science:
- Cardiovascular Imaging
- Radiology
- Diagnostic Cardiology
Background:
- Coronary artery disease (CAD) diagnosis relies on anatomical and functional assessments.
- CT myocardial perfusion imaging (CT-MPI) combined with coronary CT angiography (CTA) integrates anatomy and ischemia detection.
- Previous single-center studies show promise for CT-MPI in diagnosing significant CAD.
Purpose of the Study:
- To evaluate the diagnostic performance of dynamic stress CT-MPI combined with coronary CTA.
- To compare this combined approach against invasive coronary angiography (ICA) and invasive fractional flow reserve (FFR).
- To assess the incremental value of CT-MPI over CTA alone in identifying hemodynamically significant CAD.
Main Methods:
- International, multicenter study involving 132 patients undergoing ICA.
- 114 patients completed coronary CTA, adenosine-stress dynamic CT-MPI, and ICA.
- Invasive FFR used for vessels with 25%-90% stenosis; data analyzed by core laboratories.
Main Results:
- ICA and FFR identified significant stenoses in 26% of vessels.
- Coronary CTA (≥50% stenosis) showed 96% sensitivity, 72% specificity, 78% accuracy.
- Coronary CTA with CT-MPI demonstrated 84% sensitivity, 89% specificity, and 88% accuracy.
- Areas under the ROC curve for absolute and relative MBF were 0.79 and 0.82, respectively.
- Median radiation dose for CT-MPI and CTA were 313 mGy·cm and 138 mGy·cm.
Conclusions:
- Dynamic CT-MPI provides incremental diagnostic value beyond coronary CTA alone for significant CAD.
- The findings support broader clinical consideration of dynamic CT-MPI.
- Study identifier: SPECIFIC (NCT02810795).
Objectives:
In this international, multicenter study, using third-generation dual-source computed tomography (CT), we investigated the diagnostic performance of dynamic stress CT myocardial perfusion imaging (CT-MPI) in addition to coronary CT angiography (CTA) compared to invasive coronary angiography (ICA) and invasive fractional flow reserve (FFR).
Background:
CT-MPI combined with coronary CTA integrates coronary artery anatomy with inducible myocardial ischemia, showing promising results for the diagnosis of hemodynamically significant coronary artery disease in single-center studies.
Methods:
At 9 centers in Europe, Japan, and the United States, 132 patients scheduled for ICA were enrolled; 114 patients successfully completed coronary CTA, adenosine-stress dynamic CT-MPI, and ICA. Invasive FFR was performed in vessels with 25% to 90% stenosis. Data were analyzed by independent core laboratories. For the primary analysis, for each coronary artery the presence of hemodynamically significant obstruction was interpreted by coronary CTA with CT-MPI compared to coronary CTA alone, using an FFR of ≤0.80 and angiographic severity as reference. Territorial absolute myocardial blood flow (MBF) and relative MBF were compared using C-statistics.
Results:
ICA and FFR identified hemodynamically significant stenoses in 74 of 289 coronary vessels (26%). Coronary CTA with ≥50% stenosis demonstrated a per-vessel sensitivity, specificity, and accuracy for the detection of hemodynamically significant stenosis of 96% (95% CI: 91%-100%), 72% (95% CI: 66%-78%), and 78% (95% CI: 73%-83%), respectively. Coronary CTA with CT-MPI showed a lower sensitivity (84%; 95% CI: 75%-92%) but higher specificity (89%; 95% CI: 85%-93%) and accuracy (88%; 95% CI: 84%-92%). The areas under the receiver-operating characteristic curve of absolute MBF and relative MBF were 0.79 (95% CI: 0.71-0.86) and 0.82 (95% CI: 0.74-0.88), respectively. The median dose-length product of CT-MPI and coronary CTA were 313 mGy·cm and 138 mGy·cm, respectively.
Conclusions:
Dynamic CT-MPI offers incremental diagnostic value over coronary CTA alone for the identification of hemodynamically significant coronary artery disease. Generalized results from this multicenter study encourage broader consideration of dynamic CT-MPI in clinical practice. (Dynamic Stress Perfusion CT for Detection of Inducible Myocardial Ischemia [SPECIFIC]; NCT02810795).
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