title: Myocardial CT perfusion imaging and SPECT for the diagnosis of coronary artery disease: a head-to-head comparison from the CORE320 multicenter diagnostic performance study.
abstract: OBJECTIVE
  To compare the diagnostic performance of myocardial computed tomographic (CT) perfusion imaging and single photon emission computed tomography (SPECT) perfusion imaging in the diagnosis of anatomically significant coronary artery disease (CAD) as depicted at invasive coronary angiography.
  
  
  METHODS
  This study was approved by the institutional review board. Written informed consent was obtained from all patients. Sixteen centers enrolled 381 patients from November 2009 to July 2011. Patients underwent rest and adenosine stress CT perfusion imaging and rest and either exercise or pharmacologic stress SPECT before and within 60 days of coronary angiography. Images from CT perfusion imaging, SPECT, and coronary angiography were interpreted at blinded, independent core laboratories. The primary diagnostic parameter was the area under the receiver operating characteristic curve (Az). Sensitivity and specificity were calculated with use of prespecified cutoffs. The reference standard was a stenosis of at least 50% at coronary angiography as determined with quantitative methods.
  
  
  RESULTS
  CAD was diagnosed in 229 of the 381 patients (60%). The per-patient sensitivity and specificity for the diagnosis of CAD (stenosis ≥50%) were 88% (202 of 229 patients) and 55% (83 of 152 patients), respectively, for CT perfusion imaging and 62% (143 of 229 patients) and 67% (102 of 152 patients) for SPECT, with Az values of 0.78 (95% confidence interval: 0.74, 0.82) and 0.69 (95% confidence interval: 0.64, 0.74) (P = .001). The sensitivity of CT perfusion imaging for single- and multivessel CAD was higher than that of SPECT, with sensitivities for left main, three-vessel, two-vessel, and one-vessel disease of 92%, 92%, 89%, and 83%, respectively, for CT perfusion imaging and 75%, 79%, 68%, and 41%, respectively, for SPECT.
  
  
  CONCLUSIONS
  The overall performance of myocardial CT perfusion imaging in the diagnosis of anatomic CAD (stenosis ≥50%), as demonstrated with the Az, was higher than that of SPECT and was driven in part by the higher sensitivity for left main and multivessel disease.
authors.affiliation: From the School of Medicine, Johns Hopkins University, 600 N Wolfe St, Blalock 524D2, Baltimore, MD 21287 (R.T.G., V.C.M., A.A.Z., J.M.M., A.L.V., J.A.C.L.); Department of Epidemiology, Bloomberg School of Public Health, Baltimore, Md (M.B.M., C.C.); Department of Nuclear Medicine and Cardiovascular Imaging, Brigham and Women's Hospital, Boston, Mass (M.D.C.); Department of Cardiology, Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil (C.E.R.); National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, Md (V.C.M., M.Y.C.); Department of Radiology, Iwate Medical University, Morioka, Japan (H.N.); Department of Radiology, St. Luke's International Hospital, Tokyo, Japan (H.N.); Department of Radiology, Mie University Hospital, Tsu, Japan (K.K.); Department of Radiology, Beth Israel Deaconess Medical Center, Harvard University, Boston, MA (M.E.C.); Department of Radiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark (K.F.K.); Department of Cardiology, National Heart Center, Singapore, Singapore (T.S.Y.); and Departments of Radiology (M.D.C.) and Nuclear Medicine (W.B.), Charité-University Medicine Berlin, Berlin, Germany.
authors.forename: Richard T
authors.initials: RT
authors.lastname: George
authors.forename: Vishal C
authors.initials: VC
authors.lastname: Mehra
authors.forename: Marcus Y
authors.initials: MY
authors.lastname: Chen
authors.forename: Kakuya
authors.initials: K
authors.lastname: Kitagawa
authors.forename: Armin
authors.initials: A
authors.lastname: Arbab-Zadeh
authors.forename: Julie M
authors.initials: JM
authors.lastname: Miller
authors.forename: Matthew B
authors.initials: MB
authors.lastname: Matheson
authors.forename: Andrea L
authors.initials: AL
authors.lastname: Vavere
authors.forename: Klaus F
authors.initials: KF
authors.lastname: Kofoed
authors.forename: Carlos E
authors.initials: CE
authors.lastname: Rochitte
authors.forename: Marc
authors.initials: M
authors.lastname: Dewey
authors.forename: Tan S
authors.initials: TS
authors.lastname: Yaw
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Niinuma
authors.forename: Winfried
authors.initials: W
authors.lastname: Brenner
authors.forename: Christopher
authors.initials: C
authors.lastname: Cox
authors.forename: Melvin E
authors.initials: ME
authors.lastname: Clouse
authors.forename: João A C
authors.initials: JA
authors.lastname: Lima
authors.forename: Marcelo
authors.initials: M
authors.lastname: Di Carli
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D055414:Myocardial Perfusion Imaging / Q000379:methods*; D011446:Prospective Studies; D015899:Tomography, Emission-Computed, Single-Photon / Q000379:methods*; D014057:Tomography, X-Ray Computed / Q000379:methods*