Integrated PET/CT for the assessment of coronary artery disease: a feasibility study.
An accurate, noninvasive technique for the diagnosis of coronary artery disease (CAD) should provide complementary information on coronary anatomy and pathophysiologic lesion severity. We present, what is to our knowledge, the first clinical evaluation of integrated PET/CT for combined acquisition of coronary anatomy and perfusion.


METHODS
On an integrated PET/CT scanner, contrast-enhanced CT angiography (CTA) and rest/adenosine-stress myocardial perfusion scanning with (13)N-ammonia were performed on 25 patients with CAD documented by coronary angiography. Contrast-enhanced CTA was performed with retrospective electrocardiography gating after injection of 150 mL of intravenous contrast medium. Decisions on whether to treat with revascularization (anatomic lesion plus ischemia) or conservatively (no lesion or no ischemia) based on PET/CT were compared with those based on PET plus coronary angiography.


RESULTS
Of the 100 coronary artery segments (left main, left anterior descending, left circumflex, and right in 25 patients), 7 (in 5 patients) were considered impossible to evaluate by CT because of rapid vessel movement but were correctly categorized by PET alone. In the remaining 93 segments, the sensitivity and specificity of PET/CT versus PET plus coronary angiography were 90% and 98%, respectively. Positive and negative predictive values were 82% and 99%, and accuracy was 97%.


CONCLUSIONS
The data of this preliminary study suggest that PET/CT allows accurate noninvasive clinical decision making about CAD. Because of its high negative predictive value, PET/CT may play an important role in noninvasive selection of CAD patients for revascularization. Integration of higher-performance multislice spiral CT scanners into PET/CT hybrids will accelerate the clinical implementation of this technique.
Namdar
Mehdi
M
Nuclear Cardiology Section, Division of Cardiology, Cardiovascular Center NUK C 32, University Hospital, Raemistrasse 100, CH-8091 Zurich, Switzerland.
Hany
Thomas F
TF
Koepfli
Pascal
P
Siegrist
Patrick T
PT
Burger
Cyrill
C
Wyss
Christophe A
CA
Luscher
Thomas F
TF
von Schulthess
Gustav K
GK
Kaufmann
Philipp A
PA
D000328:Adult; D000368:Aged; D003287:Contrast Media; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D049268:Positron-Emission Tomography; D036542:Tomography, Spiral Computed
D003287:Contrast Media