title: Comparison of spiral multidetector CT angiography and myocardial perfusion imaging in the noninvasive detection of functionally relevant coronary artery lesions: first clinical experiences.
abstract: Compared with conventional coronary angiography, spiral multidetector CT (MDCT) angiography has delivered promising accuracy in the detection and validation of coronary lesions. Myocardial perfusion imaging (MPI) using SPECT is an established method for noninvasively assessing the functional significance of coronary stenoses and delivers valuable information for risk stratification. This retrospective analysis compared the accuracies of MDCT angiography and MPI in the detection of hemodynamically relevant lesions of the coronary arteries.
  
  
  METHODS
  Twenty-five patients with suspected or known coronary artery disease were studied. Electrocardiographically gated MPI and 16-MDCT angiography were performed. Myocardial perfusion images were analyzed by 2 experienced observers, and reversible and fixed perfusion defects were detected and allocated to their corresponding coronary vessels. For the evaluation of MDCT angiography, image quality was determined, and lesions > or = 50% and luminal narrowing < 50% were visually assessed and characterized by 2 independent observers unaware of the results of MPI.
  
  
  RESULTS
  Ninety-nine coronary vessels were analyzed, and the quality of MDCT angiography images was assessed for 330 coronary segments. Coronary artery diameter was interpretable for 231 (70%) of 330 segments, whereas in 99 (30%) of 330 segments, vessel diameter could not be evaluated because of heavy calcifications, blurring, motion artifacts, or intracoronary stents. MDCT angiography detected stenoses > or = 50% in 15 of 100 coronary arteries. Eight (53%) of 15 stenoses > or = 50% showed reversible or fixed perfusion defects in the corresponding myocardial areas on MPI. Sensitivity, specificity, and negative and positive predictive values were 100%, 87%, 100%, and 29%, respectively, for the ability of MDCT angiography to detect reversible perfusion defects in the corresponding myocardial areas.
  
  
  CONCLUSIONS
  MDCT angiography detected myocardial ischemia, as defined by reversible perfusion defects on MPI, with a positive predictive value of 29% in a nonselected study cohort. Compared with MPI alone, MDCT angiography added important morphologic information, but MPI remains mandatory for evaluating the functional relevance of coronary artery lesions.
authors.affiliation: Department of Nuclear Medicine, University of Munich, Germany. marcus.hacker@med.uni-muenchen.de
authors.forename: Marcus
authors.initials: M
authors.lastname: Hacker
authors.forename: Tobias
authors.initials: T
authors.lastname: Jakobs
authors.forename: Florian
authors.initials: F
authors.lastname: Matthiesen
authors.forename: Christian
authors.initials: C
authors.lastname: Vollmar
authors.forename: Konstantin
authors.initials: K
authors.lastname: Nikolaou
authors.forename: Christoph
authors.initials: C
authors.lastname: Becker
authors.forename: Andreas
authors.initials: A
authors.lastname: Knez
authors.forename: Thomas
authors.initials: T
authors.lastname: Pfluger
authors.forename: Maximilian
authors.initials: M
authors.lastname: Reiser
authors.forename: Klaus
authors.initials: K
authors.lastname: Hahn
authors.forename: Reinhold
authors.initials: R
authors.lastname: Tiling
mesh_terms: D017023:Coronary Angiography / Q000379:methods*; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging*; D005260:Female; D015637:Gated Blood-Pool Imaging / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000295:instrumentation / Q000379:methods*