title: First experience of combined cardiac PET/64-detector CT angiography with invasive angiographic validation.
abstract: 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.
authors.affiliation: Institute of Nuclear Medicine, University College London, T-5 235 Euston Rd, London NW1 2BU, UK. drashleygroves@hotmail.com
authors.forename: Ashley M
authors.initials: AM
authors.lastname: Groves
authors.forename: Marie-Elsya
authors.initials: ME
authors.lastname: Speechly-Dick
authors.forename: Irfan
authors.initials: I
authors.lastname: Kayani
authors.forename: Francesca
authors.initials: F
authors.lastname: Pugliese
authors.forename: Raymondo
authors.initials: R
authors.lastname: Endozo
authors.forename: Jean
authors.initials: J
authors.lastname: McEwan
authors.forename: Leon J
authors.initials: LJ
authors.lastname: Menezes
authors.forename: Said B
authors.initials: SB
authors.lastname: Habib
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Prvulovich
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Ell
mesh_terms: 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*