title: Diagnostic accuracy of combined coronary angiography and adenosine stress myocardial perfusion imaging using 320-detector computed tomography: pilot study.
abstract: OBJECTIVE
  To determine the diagnostic accuracy of combined 320-detector row computed tomography coronary angiography (CTA) and adenosine stress CT myocardial perfusion imaging (CTP) in detecting perfusion abnormalities caused by obstructive coronary artery disease (CAD).
  
  
  METHODS
  Twenty patients with suspected CAD who underwent initial investigation with single-photon-emission computed tomography myocardial perfusion imaging (SPECT-MPI) were recruited and underwent prospectively-gated 320-detector CTA/CTP and invasive angiography. Two blinded cardiologists evaluated invasive angiography images quantitatively (QCA). A blinded nuclear physician analysed SPECT-MPI images for fixed and reversible perfusion defects. Two blinded cardiologists assessed CTA/CTP studies qualitatively. Vessels/territories with both >50 % stenosis on QCA and corresponding perfusion defect on SPECT-MPI were defined as ischaemic and formed the reference standard.
  
  
  RESULTS
  All patients completed the CTA/CTP protocol with diagnostic image quality. Of 60 vessels/territories, 17 (28 %) were ischaemic according to QCA/SPECT-MPI criteria. Sensitivity, specificity, PPV, NPV and area under the ROC curve for CTA/CTP was 94 %, 98 %, 94 %, 98 % and 0.96 (P < 0.001) on a per-vessel/territory basis. Mean CTA/CTP radiation dose was 9.2 ± 7.4 mSv compared with 13.2 ± 2.2 mSv for SPECT-MPI (P < 0.001).
  
  
  CONCLUSIONS
  Combined 320-detector CTA/CTP is accurate in identifying obstructive CAD causing perfusion abnormalities compared with combined QCA/SPECT-MPI, achieved with lower radiation dose than SPECT-MPI.
  
  
  CONCLUSIONS
  • Advances in CT technology provides comprehensive anatomical and functional cardiac information. • Combined 320-detector CTA/adenosine-stress CTP is feasible with excellent image quality. • Combined CTA/CTP is accurate in identifying myocardial ischaemia compared with QCA/SPECT-MPI. • Combined CTA/CTP results in lower patient radiation exposure than SPECT-MPI. • CTA/CTP may become an established imaging technique for suspected CAD.
authors: Monash Cardiovascular Research Centre, Monash Heart, Department of Medicine Monash Medical Centre (MMC), Southern Health and Monash University, Melbourne, Australia.
authors: Arthur
authors: A
authors: Nasis
authors: Brian S
authors: BS
authors: Ko
authors: Michael C
authors: MC
authors: Leung
authors: Paul R
authors: PR
authors: Antonis
authors: Dee
authors: D
authors: Nandurkar
authors: Dennis T
authors: DT
authors: Wong
authors: Leo
authors: L
authors: Kyi
authors: James D
authors: JD
authors: Cameron
authors: John M
authors: JM
authors: Troupis
authors: Ian T
authors: IT
authors: Meredith
authors: Sujith K
authors: SK
authors: Seneviratne
mesh_terms: D000241:Adenosine; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017023:Coronary Angiography / Q000379:methods*; D003324:Coronary Artery Disease / Q000175:diagnosis* / Q000000981:diagnostic imaging* / Q000473:pathology; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008297:Male; D008875:Middle Aged; D055414:Myocardial Perfusion Imaging / Q000379:methods*; D015588:Observer Variation; D010477:Perfusion; D010865:Pilot Projects; D011446:Prospective Studies; D015203:Reproducibility of Results; D015899:Tomography, Emission-Computed, Single-Photon / Q000379:methods; D014057:Tomography, X-Ray Computed / Q000379:methods*
chemical_list: D000241:Adenosine