title: CT stress perfusion imaging for detection of haemodynamically relevant coronary stenosis as defined by FFR.
abstract: OBJECTIVE
  To evaluate the diagnostic accuracy (DA) of CT-myocardial perfusion imaging (CT-MPI) and a combined approach with CT angiography (CTA) for the detection of haemodynamically relevant coronary stenoses in patients with both suspected and known coronary artery disease.
  
  
  METHODS
  Prospective, non-randomised, diagnostic study.
  
  
  METHODS
  Academic hospital-based study.
  
  
  METHODS
  65 patients (42 men age 70.4±9) with typical or atypical chest pain.
  
  
  METHODS
  CTA and CT-MPI with adenosine stress using a fast dual-source CT system. At subsequent invasive angiography, FFR measurement was performed in coronary arteries to define haemodynamic relevance of stenosis.
  
  
  METHODS
  We tried to correlate haemodynamically relevant stenosis (FFR < 0.80) to a reduced myocardial blood flow (MBF) as assessed by CT-MPI and determined the DA of CT-MPI for the detection of haemodynamically relevant stenosis.
  
  
  RESULTS
  Sensitivity and negative predictive value (NPV) of CTA alone were very high (100% respectively) for ruling out haemodynamically significant stenoses, specificity, Positive predictive value (PPV) and DA were low (43.8, 67.3 and 72%, respectively). CT-MPI showed a significant increase in specificity, PPV and DA for the detection of haemodynamically relevant stenoses (65.6, 74.4 and 81.5%, respectively) with persisting high sensitivity and NPV for ruling out haemodynamically relevant stenoses (97% and 95.5% respectively). The combination of CTA and CT-MPI showed no further increase in detection of haemodynamically significant stenosis compared with CT-MPI alone.
  
  
  CONCLUSIONS
  Our data suggest that CT-MPI permits the detection of haemodynamically relevant coronary artery stenoses with a moderate DA. CT may, therefore, allow the simultaneous assessment of both coronary morphology and function.
authors.affiliation: Department of Cardiology, University Hospital of Munich, Bayern, Germany. martin.greif@med.uni-muenchen.de
authors.forename: Martin
authors.initials: M
authors.lastname: Greif
authors.forename: Franz
authors.initials: F
authors.lastname: von Ziegler
authors.forename: Fabian
authors.initials: F
authors.lastname: Bamberg
authors.forename: Janine
authors.initials: J
authors.lastname: Tittus
authors.forename: Florian
authors.initials: F
authors.lastname: Schwarz
authors.forename: Melvin
authors.initials: M
authors.lastname: D'Anastasi
authors.forename: Roy P
authors.initials: RP
authors.lastname: Marcus
authors.forename: Jan
authors.initials: J
authors.lastname: Schenzle
authors.forename: Christoph
authors.initials: C
authors.lastname: Becker
authors.forename: Konstantin
authors.initials: K
authors.lastname: Nikolaou
authors.forename: Alexander
authors.initials: A
authors.lastname: Becker
mesh_terms: D000368:Aged; D017023:Coronary Angiography / Q000379:methods*; D003326:Coronary Circulation / Q000502:physiology*; D023921:Coronary Stenosis / Q000175:diagnosis* / Q000503:physiopathology; D003937:Diagnosis, Differential; D005080:Exercise Test / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D055420:Perfusion Imaging / Q000379:methods*; D011446:Prospective Studies; D012039:Regional Blood Flow / Q000502:physiology*; D012720:Severity of Illness Index; D014057:Tomography, X-Ray Computed / Q000379:methods*
keywords: Imaging and diagnostics