Accuracy of 64-slice CT angiography for the detection of functionally relevant coronary stenoses as assessed with myocardial perfusion SPECT.
OBJECTIVE
CT angiography (CTA) offers a valuable alternative for the diagnosis of CAD but its value in the detection of functionally relevant coronary stenoses remains uncertain. We prospectively compared the accuracy of 64-slice CTA with that of myocardial perfusion imaging (MPI) using (99m)Tc-tetrofosmin-SPECT as the gold standard for the detection of functionally relevant coronary artery disease (CAD).


METHODS
MPI and 64-slice CT were performed in 100 consecutive patients. CTA lesions were analysed quantitatively and area stenoses > or =50% and > or =75% were compared with the MPI findings.


RESULTS
In 23 patients, MPI perfusion defects were found (12 reversible, 13 fixed). A total of 399 coronary arteries and 1,386 segments was analysed. Eighty-four segments (6.1%) in 23 coronary arteries (5.8%) of nine patients (9.0%) were excluded owing to insufficient image quality. In the remaining 1,302 segments, quantitative CTA revealed stenoses > or =50% in 57 of 376 coronary arteries (15.2%) and stenoses > or =75% in 32 (8.5%) coronary arteries. Using a cut-off at > or =75% area stenosis, CTA yielded the following sensitivity, specificity, negative (NPV) and positive predictive value (PPV), and accuracy for the detection of any (fixed and reversible) MPI defect: by patient, 75%, 90%, 93%, 68% and 87%, respectively; by artery, 76%, 95%, 99%, 50% and 94%, respectively.


CONCLUSIONS
Sixty-four-slice CTA is a reliable tool to rule out functionally relevant CAD in a non-selected population with an intermediate pretest likelihood of disease. However, an abnormal CTA is a poor predictor of ischaemia.
Gaemperli
Oliver
O
Nuclear Cardiology, Cardiovascular Center, University Hospital Zurich NUK C 40, Raemistrasse 100, 8091 Zurich, Switzerland.
Schepis
Tiziano
T
Koepfli
Pascal
P
Valenta
Ines
I
Soyka
Jan
J
Leschka
Sebastian
S
Desbiolles
Lotus
L
Husmann
Lars
L
Alkadhi
Hatem
H
Kaufmann
Philipp A
PA
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017023:Coronary Angiography / Q000379:methods*; D003324:Coronary Artery Disease / Q000175:diagnosis* / Q000473:pathology; D023921:Coronary Stenosis / Q000175:diagnosis; D003331:Coronary Vessels / Q000473:pathology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009206:Myocardium / Q000473:pathology*; D009943:Organophosphorus Compounds / Q000494:pharmacology; D015609:Organotechnetium Compounds / Q000494:pharmacology; D010477:Perfusion; D011446:Prospective Studies; D015899:Tomography, Emission-Computed, Single-Photon / Q000379:methods*; D014057:Tomography, X-Ray Computed / Q000379:methods*
D009943:Organophosphorus Compounds; D015609:Organotechnetium Compounds; C078700:technetium tc-99m tetrofosmin