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In Vivo Quantitative Assessment of Myocardial Structure, Function, Perfusion and Viability Using Cardiac Micro-computed Tomography
Published on: February 16, 2016
Diagnostic Performance of Dynamic Myocardial Perfusion Imaging Using Dual-Source Computed Tomography
Kakuya Kitagawa1, Satoshi Nakamura2, Hideki Ota3
1Department of Advanced Diagnostic Imaging, Mie University Graduate School of Medicine, Tsu, Japan.
Insights
Combining coronary computed tomography angiography (CTA) with dynamic computed tomography perfusion (CTP) significantly improves the accuracy of diagnosing hemodynamically significant coronary artery disease (CAD) compared to CTA alone.
Area of Science:
- Cardiovascular Imaging
- Radiology
- Medical Diagnostics
Background:
- Single-center studies suggested high accuracy for dynamic computed tomography perfusion (CTP) in diagnosing coronary artery disease (CAD).
- The need for multicenter validation of CTP's diagnostic performance in conjunction with coronary computed tomography angiography (CTA) was identified.
Purpose of the Study:
- To prospectively evaluate the diagnostic performance of combined coronary CTA and dynamic CTP for detecting hemodynamically significant CAD.
- To compare the diagnostic accuracy of combined CTA and CTP against CTA alone, using invasive coronary angiography (ICA) with fractional flow reserve (FFR) as the gold standard.
Main Methods:
- A prospective multicenter study enrolled 174 patients with suspected or known CAD referred for ICA.
- Coronary CTA and dynamic CTP were performed using dual-source CT prior to ICA.
- Fractional flow reserve (FFR) was measured during ICA for stenoses between 26% and 90% diameter reduction.
Main Results:
- The study included 157 participants, with 48% (76/157) having hemodynamically significant stenosis.
- Adding dynamic CTP to CTA significantly increased the area under the curve from 0.65 to 0.74 (P=0.011).
- Overall accuracy improved from 64% to 74% (P<0.001) with dynamic CTP, despite decreased sensitivity (93% to 72%) and improved specificity (36% to 75%).
Conclusions:
- The combination of coronary CTA and dynamic CTP enables more accurate identification of hemodynamically significant CAD than CTA alone.
- Further investigation is required to determine the clinical significance and prognostic impact of this combined imaging approach.
Background:
Single-center studies indicated a high diagnostic accuracy of dynamic computed tomography perfusion (CTP) imaging in the diagnosis of coronary artery disease (CAD).
Objectives:
This prospective multicenter study determined the diagnostic performance of combined coronary computed tomography angiography (CTA) and CTP for detecting hemodynamically significant CAD defined by invasive coronary angiography (ICA) with fractional flow reserve (FFR).
Methods:
Seven centers enrolled 174 patients with suspected or known CAD who were clinically referred for ICA. CTA and dynamic CTP were performed using dual-source CT before ICA. FFR was done as part of ICA in the case of 26% to 90% coronary diameter stenosis. Hemodynamically significant stenosis was defined as FFR of <0.8 or >90% stenosis on ICA.
Results:
The study protocol was completed in 157 participants, and hemodynamically significant stenosis was detected in 76 of 157 patients (48%) and 112 of 442 vessels (25%). According to receiver-operating characteristic curve analysis, adding dynamic CTP to CTA significantly increased the area under the curve from 0.65 (95% CI: 0.57-0.72) to 0.74 (95% CI: 0.66-0.81; P = 0.011) on the patient level, with decreased sensitivity (93% vs 72%; P < 0.001), improved specificity (36% vs 75%; P < 0.001), and improved overall accuracy (64% vs 74%; P < 0.001).
Conclusions:
In this prospective multicenter study on dynamic CTP, the combination of anatomic assessment with coronary CTA and functional evaluation with dynamic CTP allowed more accurate identification of hemodynamically significant CAD compared with CTA alone. However, the clinical significance of this approach needs to be further investigated, including its usefulness in improving prognosis. (Assessment of Myocardial Perfusion Linked to Infarction and Fibrosis Explored With Dual-Source CT [AMPLIFiED]; UMIN000016353).
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