Noninvasive assessment of myocardial ischemia in the future: fusion of anatomical and functional images?
Evaluation of: Gaemperli O, Schepis T, Valenta I et al.: Functionally relevant coronary artery disease: comparison of 64-section CT angiography with myocardial perfusion SPECT. Radiology 248(2), 414-423 (2008). Computed tomography coronary angiography (CTCA) is increasingly applied for noninvasive detection of coronary stenoses, but a major limitation of this method is the overestimation of coronary stenosis and the lack of functional information, leading to disappointing low positive-predictive values, in contrast to the high negative-predictive values. Myocardial perfusion imaging with single photon emission computed tomography (SPECT) provides functional and prognostic information, but does not give an insight into the coronary anatomy. In the recent paper in Radiology, Gaemperli et al. compared CTCA with both SPECT and conventional coronary angiography. As others, they demonstrated high specificity, but lower sensitivity of CTCA alone. However, future investigations should focus on the integration of anatomical and functional information as assessed by CTCA and SPECT. An integrated SPECT-CT may further improve diagnostic and prognostic information, and tailor patient selection for invasive treatment.
Isala Klinieken, Department of Cardiology, Groot Wezenland 20, 8011 JW Zwolle, The Netherlands.
Mohamed
M
Mouden
Jan Paul
JP
Ottervanger