title: Diagnostic performance of fusion of myocardial perfusion imaging (MPI) and computed tomography coronary angiography.
abstract: BACKGROUND
  We evaluated the incremental diagnostic value of fusion images of coronary computed tomography angiography (CTA) and myocardial perfusion imaging (MPI) over MPI alone or MPI and CTA side-by-side to identify obstructive coronary artery disease (CAD > 50% stenosis) using invasive coronary angiography (ICA) as the gold standard.
  
  
  METHODS
  50 subjects (36 men; 56 +/- 11 years old) underwent rest-stress MPI and CTA within 12-26 days of each other. CTAs were performed with multi-detector CT-scanners (31 on 64-slice; and 19 on 16-slice). 37 patients underwent ICA while 13 subjects did not because of low (<5%) pre-test likelihood (LLK) of disease. Three blinded readers scored the images in sequential sessions using (1) MPI alone (2) MPI and CTA side-by-side, (3) fused CTA/MPI images.
  
  
  RESULTS
  One or more critical stenoses during ICA were found in 28 patients and non-critical stenoses were found in 9 patients. MPI, side-by-side MPI-CTA, and fused CTA/MPI showed the same normalcy rate (NR:13/13) in LLK subjects. The fusion technique performed better than MPI and MPI and CTA side-by-side for the presence of CAD in any vessel (overall area under the curve (AUC) for fused images: 0.89; P = .005 vs MPI, P = .04 vs side-by-side MPI-CTA) and for localization of CAD to the left anterior descending coronary artery (AUC: 0.82, P < .001 vs MPI; P = .007 vs side-by-side MPI-CTA). There was a non-significant trend for better detection of multi-vessel disease with fusion.
  
  
  CONCLUSIONS
  Using ICA as the gold standard, fusion imaging provided incremental diagnostic information compared to MPI alone or side-by-side MPI-CTA for the diagnosis of obstructive CAD and for localization of CAD to the left anterior descending coronary artery.
authors.affiliation: Department of Radiology, Emory University, 1365 Clifton Road NE, AT-504, Atlanta, GA 30322, USA.
authors.forename: Cesar A
authors.initials: CA
authors.lastname: Santana
authors.forename: Ernest V
authors.initials: EV
authors.lastname: Garcia
authors.forename: Tracy L
authors.initials: TL
authors.lastname: Faber
authors.forename: Gopi K R
authors.initials: GK
authors.lastname: Sirineni
authors.forename: Fabio P
authors.initials: FP
authors.lastname: Esteves
authors.forename: Rupan
authors.initials: R
authors.lastname: Sanyal
authors.forename: Raghuveer
authors.initials: R
authors.lastname: Halkar
authors.forename: Mario
authors.initials: M
authors.lastname: Ornelas
authors.forename: Liudmila
authors.initials: L
authors.lastname: Verdes
authors.forename: Stamatios
authors.initials: S
authors.lastname: Lerakis
authors.forename: Julie J
authors.initials: JJ
authors.lastname: Ramos
authors.forename: Santiago
authors.initials: S
authors.lastname: Aguadé-Bruix
authors.forename: Hugo
authors.initials: H
authors.lastname: Cuéllar
authors.forename: Jaume
authors.initials: J
authors.lastname: Candell-Riera
authors.forename: Paolo
authors.initials: P
authors.lastname: Raggi
mesh_terms: D017023:Coronary Angiography / Q000379:methods*; D003324:Coronary Artery Disease / Q000150:complications / Q000175:diagnosis*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D013382:Subtraction Technique; D015899:Tomography, Emission-Computed, Single-Photon / Q000379:methods*; D014057:Tomography, X-Ray Computed / Q000379:methods*; D018487:Ventricular Dysfunction, Left / Q000175:diagnosis* / Q000209:etiology