Computed tomography myocardial perfusion vs ¹⁵O-water positron emission tomography and fractional flow reserve
File(s)10.1007%2Fs00330-016-4404-5.pdf (4.92 MB)
Published version
Author(s)
Type
Journal Article
Abstract
Objectives:
Computed tomography (CT) can perform comprehensive cardiac imaging. We compared CT coronary angiography (CTCA) and CT myocardial perfusion (CTP) with ¹⁵O-water positron emission tomography (PET) and invasive coronary angiography (ICA) with fractional flow reserve (FFR).
Methods:
51 patients (63 (61–65) years, 80 % male) with known/suspected coronary artery disease (CAD) underwent 320-multidetector CTCA followed by “snapshot” adenosine stress CTP. Of these 22 underwent PET and 47 ICA/FFR. Obstructive CAD was defined as CTCA stenosis >50 % and CTP hypoperfusion, ICA stenosis >70 % or FFR <0.80.
Results:
PET hyperaemic myocardial blood flow (MBF) was lower in obstructive than non-obstructive territories defined by ICA/FFR (1.76 (1.32–2.20) vs 3.11 (2.44–3.79) mL/(g/min), P < 0.001) and CTCA/CTP (1.76 (1.32–2.20) vs 3.12 (2.44–3.79) mL/(g/min), P < 0.001). Baseline and hyperaemic CT attenuation density was lower in obstructive than non-obstructive territories (73 (71–76) vs 86 (84–88) HU, P < 0.001 and 101 (96–106) vs 111 (107–114) HU, P 0.001). PET hyperaemic MBF corrected for rate pressure product correlated with CT attenuation density (r = 0.579, P < 0.001). There was excellent per-patient sensitivity (96 %), specificity (85 %), negative predictive value (90 %) and positive predictive value (94 %) for CTCA/CTP vs ICA/FFR.
Conclusion:
CT myocardial attenuation density correlates with ¹⁵O-water PET MBF. CTCA and CTP can accurately identify obstructive CAD.
Key Points:
•CT myocardial perfusion can aid the assessment of suspected coronary artery disease.
• CT attenuation density from “snapshot” imaging is a marker of myocardial perfusion.
• CT myocardial attenuation density correlates with ¹⁵O-water PET myocardial blood flow.
• CT attenuation density is lower in obstructive territories defined by invasive angiography.
• Diagnostic accuracy of CTCA+CTP is comparable to invasive angiography + fractional flow reserve.
Computed tomography (CT) can perform comprehensive cardiac imaging. We compared CT coronary angiography (CTCA) and CT myocardial perfusion (CTP) with ¹⁵O-water positron emission tomography (PET) and invasive coronary angiography (ICA) with fractional flow reserve (FFR).
Methods:
51 patients (63 (61–65) years, 80 % male) with known/suspected coronary artery disease (CAD) underwent 320-multidetector CTCA followed by “snapshot” adenosine stress CTP. Of these 22 underwent PET and 47 ICA/FFR. Obstructive CAD was defined as CTCA stenosis >50 % and CTP hypoperfusion, ICA stenosis >70 % or FFR <0.80.
Results:
PET hyperaemic myocardial blood flow (MBF) was lower in obstructive than non-obstructive territories defined by ICA/FFR (1.76 (1.32–2.20) vs 3.11 (2.44–3.79) mL/(g/min), P < 0.001) and CTCA/CTP (1.76 (1.32–2.20) vs 3.12 (2.44–3.79) mL/(g/min), P < 0.001). Baseline and hyperaemic CT attenuation density was lower in obstructive than non-obstructive territories (73 (71–76) vs 86 (84–88) HU, P < 0.001 and 101 (96–106) vs 111 (107–114) HU, P 0.001). PET hyperaemic MBF corrected for rate pressure product correlated with CT attenuation density (r = 0.579, P < 0.001). There was excellent per-patient sensitivity (96 %), specificity (85 %), negative predictive value (90 %) and positive predictive value (94 %) for CTCA/CTP vs ICA/FFR.
Conclusion:
CT myocardial attenuation density correlates with ¹⁵O-water PET MBF. CTCA and CTP can accurately identify obstructive CAD.
Key Points:
•CT myocardial perfusion can aid the assessment of suspected coronary artery disease.
• CT attenuation density from “snapshot” imaging is a marker of myocardial perfusion.
• CT myocardial attenuation density correlates with ¹⁵O-water PET myocardial blood flow.
• CT attenuation density is lower in obstructive territories defined by invasive angiography.
• Diagnostic accuracy of CTCA+CTP is comparable to invasive angiography + fractional flow reserve.
Date Issued
2017-03-01
Date Acceptance
2016-05-12
Citation
European Radiology, 2017, 27 (3), pp.1114-1124
ISSN
0938-7994
Publisher
Springer Verlag
Start Page
1114
End Page
1124
Journal / Book Title
European Radiology
Volume
27
Issue
3
Copyright Statement
© The Author(s) 2016. This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.
Identifier
http://gateway.webofknowledge.com/gateway/Gateway.cgi?GWVersion=2&SrcApp=PARTNER_APP&SrcAuth=LinksAMR&KeyUT=WOS:000394313900025&DestLinkType=FullRecord&DestApp=ALL_WOS&UsrCustomerID=1ba7043ffcc86c417c072aa74d649202
Subjects
Science & Technology
Life Sciences & Biomedicine
Radiology, Nuclear Medicine & Medical Imaging
Imaging
Perfusion
Ischaemia
Angiography
Angina
CORONARY-ARTERY-DISEASE
DUAL-SOURCE CT
BLOOD-FLOW
OXYGEN-15-LABELED WATER
MAGNETIC-RESONANCE
INCREMENTAL VALUE
ANGIOGRAPHY
STRESS
QUANTIFICATION
PET
Publication Status
Published