Incremental value of combining 64-slice computed tomography angiography with stress nuclear myocardial perfusion imaging to improve noninvasive detection of coronary artery disease.
BACKGROUND
To compare the accuracy of combined 64-slice computed tomography angiography (CTA) and stress nuclear myocardial perfusion imaging (MPI) in the noninvasive detection of coronary artery disease (CAD) with that of 64-slice CTA alone.


RESULTS
One hundred thirty symptomatic patients with suspected CAD underwent both 64-slice CTA and stress thallium-201 MPI before invasive coronary angiography (ICA). Coronary lesions with >or=50% luminal narrowing were considered as significant stenoses on CTA and ICA. Of 390 arteries in 130 patients, 54 (14%) were nonevaluable by CTA due to severe calcifications, motion artifacts, and/or poor opacification. All nonevaluable arteries were considered positive. The sensitivity, specificity, PPV and NPV were 95%, 80%, 69%, and 97%, respectively, for CTA alone and 94%, 92%, 85%, and 97%, respectively, for CTA with stress nuclear MPI for all nonevaluable arteries on CTA. Per-patient analysis showed significant increase in specificity and PPV. The majority (75%, 9/12) of nonevaluable severely calcified vessels in the left anterior descending artery were positive on stress nuclear MPI, whereas the majority (89%, 8/9) of nonevaluable vessels with motion artifacts in the right coronary artery were negative.


CONCLUSIONS
Combined CTA and stress nuclear MPI provide improved diagnostic accuracy for the noninvasive detection of CAD.
Cardiovascular Division, Institute of Clinical Medicine, Graduate School of Comprehensive Human Sciences, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan. asato@md.tsukuba.ac.jp
Akira
A
Sato
Toshihiro
T
Nozato
Hiroyuki
H
Hikita
Shinsuke
S
Miyazaki
Yoshihide
Y
Takahashi
Taishi
T
Kuwahara
Atsushi
A
Takahashi
Michiaki
M
Hiroe
Kazutaka
K
Aonuma
D000368:Aged; D017023:Coronary Angiography / Q000706:statistics & numerical data*; D003324:Coronary Artery Disease / Q000175:diagnosis* / Q000453:epidemiology*; D005260:Female; D006801:Humans; D007089:Image Enhancement / Q000379:methods; D007564:Japan / Q000453:epidemiology; D008297:Male; D055414:Myocardial Perfusion Imaging / Q000706:statistics & numerical data*; D015995:Prevalence; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D015899:Tomography, Emission-Computed, Single-Photon / Q000706:statistics & numerical data*; D014057:Tomography, X-Ray Computed / Q000706:statistics & numerical data*