title: Computed tomography angiography and perfusion to assess coronary artery stenosis causing perfusion defects by single photon emission computed tomography: the CORE320 study.
abstract: OBJECTIVE
  To evaluate the diagnostic power of integrating the results of computed tomography angiography (CTA) and CT myocardial perfusion (CTP) to identify coronary artery disease (CAD) defined as a flow limiting coronary artery stenosis causing a perfusion defect by single photon emission computed tomography (SPECT).
  
  
  RESULTS
  We conducted a multicentre study to evaluate the accuracy of integrated CTA-CTP for the identification of patients with flow-limiting CAD defined by ≥50% stenosis by invasive coronary angiography (ICA) with a corresponding perfusion deficit on stress single photon emission computed tomography (SPECT/MPI). Sixteen centres enroled 381 patients who underwent combined CTA-CTP and SPECT/MPI prior to conventional coronary angiography. All four image modalities were analysed in blinded independent core laboratories. The prevalence of obstructive CAD defined by combined ICA-SPECT/MPI and ICA alone was 38 and 59%, respectively. The patient-based diagnostic accuracy defined by the area under the receiver operating characteristic curve (AUC) of integrated CTA-CTP for detecting or excluding flow-limiting CAD was 0.87 [95% confidence interval (CI): 0.84-0.91]. In patients without prior myocardial infarction, the AUC was 0.90 (95% CI: 0.87-0.94) and in patients without prior CAD the AUC for combined CTA-CTP was 0.93 (95% CI: 0.89-0.97). For the combination of a CTA stenosis ≥50% stenosis and a CTP perfusion deficit, the sensitivity, specificity, positive predictive, and negative predicative values (95% CI) were 80% (72-86), 74% (68-80), 65% (58-72), and 86% (80-90), respectively. For flow-limiting disease defined by ICA-SPECT/MPI, the accuracy of CTA was significantly increased by the addition of CTP at both the patient and vessel levels.
  
  
  CONCLUSIONS
  The combination of CTA and perfusion correctly identifies patients with flow limiting CAD defined as ≥50 stenosis by ICA causing a perfusion defect by SPECT/MPI.
authors.affiliation: Division of Cardiology, Department of Medicine, Johns Hopkins Hospital and School of Medicine, 600 N. Wolfe St., Blalock 524, Baltimore, MD 21287, USA.
authors.forename: Carlos E
authors.initials: CE
authors.lastname: Rochitte
authors.forename: Richard T
authors.initials: RT
authors.lastname: George
authors.forename: Marcus Y
authors.initials: MY
authors.lastname: Chen
authors.forename: Armin
authors.initials: A
authors.lastname: Arbab-Zadeh
authors.forename: Marc
authors.initials: M
authors.lastname: Dewey
authors.forename: Julie M
authors.initials: JM
authors.lastname: Miller
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Niinuma
authors.forename: Kunihiro
authors.initials: K
authors.lastname: Yoshioka
authors.forename: Kakuya
authors.initials: K
authors.lastname: Kitagawa
authors.forename: Shiro
authors.initials: S
authors.lastname: Nakamori
authors.forename: Roger
authors.initials: R
authors.lastname: Laham
authors.forename: Andrea L
authors.initials: AL
authors.lastname: Vavere
authors.forename: Rodrigo J
authors.initials: RJ
authors.lastname: Cerci
authors.forename: Vishal C
authors.initials: VC
authors.lastname: Mehra
authors.forename: Cesar
authors.initials: C
authors.lastname: Nomura
authors.forename: Klaus F
authors.initials: KF
authors.lastname: Kofoed
authors.forename: Masahiro
authors.initials: M
authors.lastname: Jinzaki
authors.forename: Sachio
authors.initials: S
authors.lastname: Kuribayashi
authors.forename: Albert
authors.initials: A
authors.lastname: de Roos
authors.forename: Michael
authors.initials: M
authors.lastname: Laule
authors.forename: Swee Yaw
authors.initials: SY
authors.lastname: Tan
authors.forename: John
authors.initials: J
authors.lastname: Hoe
authors.forename: Narinder
authors.initials: N
authors.lastname: Paul
authors.forename: Frank J
authors.initials: FJ
authors.lastname: Rybicki
authors.forename: Jeffery A
authors.initials: JA
authors.lastname: Brinker
authors.forename: Andrew E
authors.initials: AE
authors.lastname: Arai
authors.forename: Christopher
authors.initials: C
authors.lastname: Cox
authors.forename: Melvin E
authors.initials: ME
authors.lastname: Clouse
authors.forename: Marcelo F
authors.initials: MF
authors.lastname: Di Carli
authors.forename: Joao A C
authors.initials: JA
authors.lastname: Lima
mesh_terms: D000368:Aged; D023921:Coronary Stenosis / Q000000981:diagnostic imaging* / Q000503:physiopathology; D005260:Female; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography; D055414:Myocardial Perfusion Imaging / Q000379:methods; D011446:Prospective Studies; D012372:ROC Curve; D012680:Sensitivity and Specificity; D015899:Tomography, Emission-Computed, Single-Photon / Q000379:methods*
keywords: Atherosclerosis; Imaging; Ischemia; Multislice computed tomography; Perfusion