First experience of combined cardiac PET/64-detector CT angiography with invasive angiographic validation.
OBJECTIVE
Despite modern CT systems and expert evaluators, the diagnostic performance of coronary CT angiography is limited by overestimation of vessel stenosis which reduces the positive predictive value (PPV) of the test. The aim of this study was to evaluate the performance of combined cardiac PET/64-detector CT angiography.


METHODS
Included in this retrospective study were 33 consecutive patients (5 women, 28 men; mean age 61.6 years, range 47-87 years, mean BMI 27.3+/-5.2 kg/m(2)) with clinically suspected flow-limiting coronary artery disease who underwent combined cardiac PET/64-detector CT angiography and invasive angiography. Combined PET/CT images were reported by an experienced dual-accredited radiologist/nuclear physician. An experienced cardiac CT radiologist re-read the CT images without PET. Stenotic disease was defined as >50% vessel narrowing. Invasive coronary angiography was used as a reference standard. Local ethics committee approval and patient consent were obtained.


RESULTS
CT angiography (without PET data) was concordant with invasive angiography in 31/33 patients and at a patient level, the sensitivity in detecting significant coronary artery lesions was 100%, the specificity was 82%, the PPV was 92% and the negative predictive value (NPV) was 100%. Using combined PET/CT angiography the findings were concordant with invasive angiography in 32/33 patients and at a patient level, the sensitivity was 96%, the specificity was 100%, the PPV was 100% and the NPV was 91%.


CONCLUSIONS
The use of integrated cardiac PET/64-detector CT angiography is feasible and appears to improve some aspects of the diagnostic performance of 64-detector coronary artery angiography in detecting coronary artery disease.
Groves
Ashley M
AM
Institute of Nuclear Medicine, University College London, T-5 235 Euston Rd, London NW1 2BU, UK. drashleygroves@hotmail.com
Speechly-Dick
Marie-Elsya
ME
Kayani
Irfan
I
Pugliese
Francesca
F
Endozo
Raymondo
R
McEwan
Jean
J
Menezes
Leon J
LJ
Habib
Said B
SB
Prvulovich
Elizabeth
E
Ell
Peter J
PJ
D000368:Aged; D017023:Coronary Angiography / Q000379:methods* / Q000592:standards; D023921:Coronary Stenosis / Q000000981:diagnostic imaging / Q000503:physiopathology; D005260:Female; D006321:Heart / Q000000981:diagnostic imaging* / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D055414:Myocardial Perfusion Imaging; D015588:Observer Variation; D049268:Positron-Emission Tomography / Q000379:methods*; D012015:Reference Standards; D012189:Retrospective Studies; D013318:Stroke Volume; D018511:Systems Integration; D014057:Tomography, X-Ray Computed / Q000379:methods*