Clinical study on coronary computed tomography angiography and myocardial perfusion imaging in quantitative assessment of flow-limiting stenoses

doi:10.3969/j.issn.1006-7795.2013.01.007

Abstract

Abstract:

Objective To evaluate the diagnostic accuracy of a combined non-invasive assessment of coronary artery disease with coronary computed tomography angiography (CCTA) and myocardial perfusion imaging (MPI) for the detection of flow-limiting coronary stenoses and its potential as a gatekeeper for invasive examination and treatment. Methods A total of 78 patients with known or suspected coronary artery disease (CAD) were examined by adenosine stress/rest MPI and coronary angiography (CAG) within one month, at the same time these patients underwent CCTA with the same SPECT/CT facility. MPI was evaluated by semi- quantitative visual interpretation using a 15-segment model. According to CAG and CCTA standard, a significant stenosis was defined as a diameter reduction of ≥50%. Detection of flow-limiting stenoses (justifying revascularization) by the combination of CCTA and MPI (MPI/CCTA) was compared with the combination of CAG plus MPI (MPI/CAG), which served as standard of reference.Results In 78 patients, MPI image revealed 66 reversible, 6 fixed and 6 normal.The distribution of the perfusion defects among the different coronary artery territories was as follows: reversible perfusion defects: left anterior descending artery(LAD)(n=55), left circumflex artery (LCX)(n=14), right coronary artery(RCA)(n=11); fixed perfusion defects: LAD(n=4); RCA(n=3). CCTA image analysis revealed a stenosis in 74/234 coronary arteries of 56/78 patients. MPI/CCTA image analysis revealed a stenosis in 56/78 patients. The diagnostic sensitivity, specificity, accuracy, positive and negative predictive values by MPI/CCTA vs MPI/CAG for the detection of flow-limiting coronary stenosis on patient-based and vessel-based analysis were 94.33%, 72.00%, 87.18%, 87.71%, 85.71% and 88.71%, 92.44%, 91.45%, 80.89%, 95.78%. All of revascularization procedures (46,100%) were associated with ischemia on MPI, but more than a third(25/67,37%)of revascularized vessels were not associated with ischemia on MPI. Conclusion The combined non-invasive approach MPI/CCTA has an excellent acuracy to detect flow-limiting coronary stenoses compared with MPI/CAG. Its advantage lies in the non-invasive evaluation of coronary anatomy and function, and its use as a gatekeeper appears to make a substantial part of revascularization procedures redundant.

Key words: coronary artery disease, myocardial perfusion imaging, fusion imaging technique, myocardial ischemia

CLC Number:

R541.4

GU Shanshan, WANG Qian, DONG Wei, JIAO Jian, SU Hang, FU Ying. Clinical study on coronary computed tomography angiography and myocardial perfusion imaging in quantitative assessment of flow-limiting stenoses[J]. Journal of Capital Medical University, 2013, 34(1): 36-42.

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URL: https://journal03.magtech.org.cn/Jweb_sdykdxxb/EN/10.3969/j.issn.1006-7795.2013.01.007

https://journal03.magtech.org.cn/Jweb_sdykdxxb/EN/Y2013/V34/I1/36

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