Direct comparison of stress- and rest-dual-energy computed tomography for detection of myocardial perfusion defect.
We assessed the diagnostic performance of stress- and rest-dual-energy computed tomography (DECT) and their incremental value when used with coronary CT angiography (CCTA) compared with combined invasive coronary angiography (ICA)/cardiovascular magnetic resonance (CMR) for detecting hemodynamically significant stenosis causing a myocardial perfusion defect. Forty patients (30 men; mean age, 63.4 ± 8.8 years) with known or suspected coronary artery disease detected by CCTA underwent stress- and rest-DECT, CMR, and ICA. DECT iodine maps were compared with CMR on a per-segment and per-vessel basis. Diagnostic value of CCTA was assessed on a per-vessel basis before and after stress- and rest-DECT and compared to that of ICA/CMR. Compared to CMR, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of rest-DECT for detecting segment (vessel)-based perfusion defects were 29% (46%), 88% (79%), 56% (61%), and 70% (67%), respectively. Corresponding values using stress-DECT were 73% (94%), 83% (74%), 70% (72%), and 85% (95%), respectively. There was fair (κ = 0.39) agreement between rest- and stress-DECT iodine maps in identifying segments with perfusion defects. Compared with the ICA/CMR for identifying hemodynamically significant stenoses, per-vessel territory sensitivity, specificity, PPV, and NPV of CCTA were 91, 56, 55, and 91%, respectively; those using CCTA/rest-DECT were 42, 83, 59, and 70%, respectively; and those using CCTA/stress-DECT were 87, 79, 71, and 91%, respectively. The area under the receiver operating characteristic curve decreased from 0.74 to 0.62 (P = 0.06) using CCTA/rest-DECT but increased to 0.83 (P = 0.02) using CCTA/stress-DECT. Stress-DECT has incremental value when used with CCTA for detecting hemodynamically significant stenoses.
Department of Radiology, Konkuk University Medical Center, Konkuk University School of Medicine, 4-12 Hwayang-dong, Gwangjin-gu, Seoul, 143-729, Korea.
Sung Min
SM
Ko
Jeong Hee
JH
Park
Hweung Kon
HK
Hwang
Meong Gun
MG
Song
D000241:Adenosine; D003287:Contrast Media; D017023:Coronary Angiography / Q000379:methods*; D003324:Coronary Artery Disease / Q000150:complications; D023921:Coronary Stenosis / Q000175:diagnosis*; D004562:Electrocardiography; D005260:Female; D006801:Humans; D007472:Iohexol / Q000031:analogs & derivatives; D019028:Magnetic Resonance Imaging, Cine; D008297:Male; D008536:Meglumine; D008875:Middle Aged; D009942:Organometallic Compounds; D011237:Predictive Value of Tests; D012146:Rest; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D014057:Tomography, X-Ray Computed / Q000379:methods*; D014665:Vasodilator Agents
D003287:Contrast Media; D009942:Organometallic Compounds; D014665:Vasodilator Agents; D007472:Iohexol; D008536:Meglumine; C038192:iopromide; D000241:Adenosine; C072417:gadoterate meglumine