title: Stress Myocardial Perfusion CT in Patients Suspected of Having Coronary Artery Disease: Visual and Quantitative Analysis-Validation by Using Fractional Flow Reserve.
abstract: OBJECTIVE
  To assess the diagnostic accuracy of stress myocardial perfusion computed tomography (CT) by using visual and quantitative analytic methods in patients with coronary artery disease, with fractional flow reserve (FFR) as a reference standard.
  
  
  METHODS
  The institutional review board approved the study, and written informed consent was obtained from all patients. The diagnostic accuracy of myocardial perfusion CT was assessed for 75 patients who underwent myocardial perfusion CT and conventional coronary angiography with reference to hemodynamically significant stenosis, defined as the presence of an FFR of 0.8 or less or an angiographically severe (≥90%) stenosis. Results of quantitative analysis of myocardial perfusion CT data were compared with those of visual analysis by using areas under the receiver operating characteristic curve (AUCs).
  
  
  RESULTS
  Among the 75 patients and 210 epicardial arteries, 61 patients (81%) with 86 arteries (41%) had hemodynamically significant stenosis. The per-patient sensitivity and specificity of the visual assessment of myocardial perfusion CT data for all patients were 89% and 86%, respectively. At per-vessel analysis, the sensitivities and specificities, respectively, of myocardial perfusion CT were 80% and 95% for all vessels, 85% and 100% for 63 vessels with severe coronary calcification (defined as an Agatston score > 400), and 76% and 91% for 56 vessels in patients with multivessel disease. In severely calcified vessels, visual assessment of myocardial perfusion CT data in combination with CT angiography provided incremental value over CT angiography alone for the detection of myocardial ischemia (integrated discrimination improvement index, 0.38; P < .001). Quantitative assessment of transmural perfusion ratio had a lower AUC than visual analysis of myocardial perfusion CT (0.759 vs 0.877, P = .002).
  
  
  CONCLUSIONS
  Stress myocardial perfusion CT provides incremental value over CT angiography in patients with a high calcium score for the detection of myocardial ischemia as defined by FFR.
authors.affiliation: From the Department of Radiology (D.H.Y., J.W.K., D.H., N.K., T.H.L.), Research Institute of Radiology, Department of Cardiology (Y.H.K., J.H.R., J.J., J.M.A., J.Y.L., D.W.P., S.H.K., S.W.L., C.W.L., S.W.P., S.J.P.), and Heart Institute, Department of Clinical Epidemiology and Biostatistics (J.B.L.), Asan Medical Center, University of Ulsan College of Medicine, Asanbyeongwon-gil 86, Seoul 138-736, South Korea.
authors.forename: Dong Hyun
authors.initials: DH
authors.lastname: Yang
authors.affiliation: From the Department of Radiology (D.H.Y., J.W.K., D.H., N.K., T.H.L.), Research Institute of Radiology, Department of Cardiology (Y.H.K., J.H.R., J.J., J.M.A., J.Y.L., D.W.P., S.H.K., S.W.L., C.W.L., S.W.P., S.J.P.), and Heart Institute, Department of Clinical Epidemiology and Biostatistics (J.B.L.), Asan Medical Center, University of Ulsan College of Medicine, Asanbyeongwon-gil 86, Seoul 138-736, South Korea.
authors.forename: Young-Hak
authors.initials: YH
authors.lastname: Kim
authors.affiliation: From the Department of Radiology (D.H.Y., J.W.K., D.H., N.K., T.H.L.), Research Institute of Radiology, Department of Cardiology (Y.H.K., J.H.R., J.J., J.M.A., J.Y.L., D.W.P., S.H.K., S.W.L., C.W.L., S.W.P., S.J.P.), and Heart Institute, Department of Clinical Epidemiology and Biostatistics (J.B.L.), Asan Medical Center, University of Ulsan College of Medicine, Asanbyeongwon-gil 86, Seoul 138-736, South Korea.
authors.forename: Jae-Hyung
authors.initials: JH
authors.lastname: Roh
authors.affiliation: From the Department of Radiology (D.H.Y., J.W.K., D.H., N.K., T.H.L.), Research Institute of Radiology, Department of Cardiology (Y.H.K., J.H.R., J.J., J.M.A., J.Y.L., D.W.P., S.H.K., S.W.L., C.W.L., S.W.P., S.J.P.), and Heart Institute, Department of Clinical Epidemiology and Biostatistics (J.B.L.), Asan Medical Center, University of Ulsan College of Medicine, Asanbyeongwon-gil 86, Seoul 138-736, South Korea.
authors.forename: Joon-Won
authors.initials: JW
authors.lastname: Kang
authors.affiliation: From the Department of Radiology (D.H.Y., J.W.K., D.H., N.K., T.H.L.), Research Institute of Radiology, Department of Cardiology (Y.H.K., J.H.R., J.J., J.M.A., J.Y.L., D.W.P., S.H.K., S.W.L., C.W.L., S.W.P., S.J.P.), and Heart Institute, Department of Clinical Epidemiology and Biostatistics (J.B.L.), Asan Medical Center, University of Ulsan College of Medicine, Asanbyeongwon-gil 86, Seoul 138-736, South Korea.
authors.forename: Dongjin
authors.initials: D
authors.lastname: Han
authors.affiliation: From the Department of Radiology (D.H.Y., J.W.K., D.H., N.K., T.H.L.), Research Institute of Radiology, Department of Cardiology (Y.H.K., J.H.R., J.J., J.M.A., J.Y.L., D.W.P., S.H.K., S.W.L., C.W.L., S.W.P., S.J.P.), and Heart Institute, Department of Clinical Epidemiology and Biostatistics (J.B.L.), Asan Medical Center, University of Ulsan College of Medicine, Asanbyeongwon-gil 86, Seoul 138-736, South Korea.
authors.forename: Joonho
authors.initials: J
authors.lastname: Jung
authors.affiliation: From the Department of Radiology (D.H.Y., J.W.K., D.H., N.K., T.H.L.), Research Institute of Radiology, Department of Cardiology (Y.H.K., J.H.R., J.J., J.M.A., J.Y.L., D.W.P., S.H.K., S.W.L., C.W.L., S.W.P., S.J.P.), and Heart Institute, Department of Clinical Epidemiology and Biostatistics (J.B.L.), Asan Medical Center, University of Ulsan College of Medicine, Asanbyeongwon-gil 86, Seoul 138-736, South Korea.
authors.forename: Namkug
authors.initials: N
authors.lastname: Kim
authors.affiliation: From the Department of Radiology (D.H.Y., J.W.K., D.H., N.K., T.H.L.), Research Institute of Radiology, Department of Cardiology (Y.H.K., J.H.R., J.J., J.M.A., J.Y.L., D.W.P., S.H.K., S.W.L., C.W.L., S.W.P., S.J.P.), and Heart Institute, Department of Clinical Epidemiology and Biostatistics (J.B.L.), Asan Medical Center, University of Ulsan College of Medicine, Asanbyeongwon-gil 86, Seoul 138-736, South Korea.
authors.forename: Jung Bok
authors.initials: JB
authors.lastname: Lee
authors.affiliation: From the Department of Radiology (D.H.Y., J.W.K., D.H., N.K., T.H.L.), Research Institute of Radiology, Department of Cardiology (Y.H.K., J.H.R., J.J., J.M.A., J.Y.L., D.W.P., S.H.K., S.W.L., C.W.L., S.W.P., S.J.P.), and Heart Institute, Department of Clinical Epidemiology and Biostatistics (J.B.L.), Asan Medical Center, University of Ulsan College of Medicine, Asanbyeongwon-gil 86, Seoul 138-736, South Korea.
authors.forename: Jung-Min
authors.initials: JM
authors.lastname: Ahn
authors.affiliation: From the Department of Radiology (D.H.Y., J.W.K., D.H., N.K., T.H.L.), Research Institute of Radiology, Department of Cardiology (Y.H.K., J.H.R., J.J., J.M.A., J.Y.L., D.W.P., S.H.K., S.W.L., C.W.L., S.W.P., S.J.P.), and Heart Institute, Department of Clinical Epidemiology and Biostatistics (J.B.L.), Asan Medical Center, University of Ulsan College of Medicine, Asanbyeongwon-gil 86, Seoul 138-736, South Korea.
authors.forename: Jong-Young
authors.initials: JY
authors.lastname: Lee
authors.affiliation: From the Department of Radiology (D.H.Y., J.W.K., D.H., N.K., T.H.L.), Research Institute of Radiology, Department of Cardiology (Y.H.K., J.H.R., J.J., J.M.A., J.Y.L., D.W.P., S.H.K., S.W.L., C.W.L., S.W.P., S.J.P.), and Heart Institute, Department of Clinical Epidemiology and Biostatistics (J.B.L.), Asan Medical Center, University of Ulsan College of Medicine, Asanbyeongwon-gil 86, Seoul 138-736, South Korea.
authors.forename: Duk-Woo
authors.initials: DW
authors.lastname: Park
authors.affiliation: From the Department of Radiology (D.H.Y., J.W.K., D.H., N.K., T.H.L.), Research Institute of Radiology, Department of Cardiology (Y.H.K., J.H.R., J.J., J.M.A., J.Y.L., D.W.P., S.H.K., S.W.L., C.W.L., S.W.P., S.J.P.), and Heart Institute, Department of Clinical Epidemiology and Biostatistics (J.B.L.), Asan Medical Center, University of Ulsan College of Medicine, Asanbyeongwon-gil 86, Seoul 138-736, South Korea.
authors.forename: Soo-Jin
authors.initials: SJ
authors.lastname: Kang
authors.affiliation: From the Department of Radiology (D.H.Y., J.W.K., D.H., N.K., T.H.L.), Research Institute of Radiology, Department of Cardiology (Y.H.K., J.H.R., J.J., J.M.A., J.Y.L., D.W.P., S.H.K., S.W.L., C.W.L., S.W.P., S.J.P.), and Heart Institute, Department of Clinical Epidemiology and Biostatistics (J.B.L.), Asan Medical Center, University of Ulsan College of Medicine, Asanbyeongwon-gil 86, Seoul 138-736, South Korea.
authors.forename: Seung-Whan
authors.initials: SW
authors.lastname: Lee
authors.affiliation: From the Department of Radiology (D.H.Y., J.W.K., D.H., N.K., T.H.L.), Research Institute of Radiology, Department of Cardiology (Y.H.K., J.H.R., J.J., J.M.A., J.Y.L., D.W.P., S.H.K., S.W.L., C.W.L., S.W.P., S.J.P.), and Heart Institute, Department of Clinical Epidemiology and Biostatistics (J.B.L.), Asan Medical Center, University of Ulsan College of Medicine, Asanbyeongwon-gil 86, Seoul 138-736, South Korea.
authors.forename: Cheol Whan
authors.initials: CW
authors.lastname: Lee
authors.affiliation: From the Department of Radiology (D.H.Y., J.W.K., D.H., N.K., T.H.L.), Research Institute of Radiology, Department of Cardiology (Y.H.K., J.H.R., J.J., J.M.A., J.Y.L., D.W.P., S.H.K., S.W.L., C.W.L., S.W.P., S.J.P.), and Heart Institute, Department of Clinical Epidemiology and Biostatistics (J.B.L.), Asan Medical Center, University of Ulsan College of Medicine, Asanbyeongwon-gil 86, Seoul 138-736, South Korea.
authors.forename: Seong-Wook
authors.initials: SW
authors.lastname: Park
authors.affiliation: From the Department of Radiology (D.H.Y., J.W.K., D.H., N.K., T.H.L.), Research Institute of Radiology, Department of Cardiology (Y.H.K., J.H.R., J.J., J.M.A., J.Y.L., D.W.P., S.H.K., S.W.L., C.W.L., S.W.P., S.J.P.), and Heart Institute, Department of Clinical Epidemiology and Biostatistics (J.B.L.), Asan Medical Center, University of Ulsan College of Medicine, Asanbyeongwon-gil 86, Seoul 138-736, South Korea.
authors.forename: Seung-Jung
authors.initials: SJ
authors.lastname: Park
authors.affiliation: From the Department of Radiology (D.H.Y., J.W.K., D.H., N.K., T.H.L.), Research Institute of Radiology, Department of Cardiology (Y.H.K., J.H.R., J.J., J.M.A., J.Y.L., D.W.P., S.H.K., S.W.L., C.W.L., S.W.P., S.J.P.), and Heart Institute, Department of Clinical Epidemiology and Biostatistics (J.B.L.), Asan Medical Center, University of Ulsan College of Medicine, Asanbyeongwon-gil 86, Seoul 138-736, South Korea.
authors.forename: Tae-Hwan
authors.initials: TH
authors.lastname: Lim
mesh_terms: D017023:Coronary Angiography / Q000379:methods; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D005260:Female; D053805:Fractional Flow Reserve, Myocardial; D006801:Humans; D008297:Male; D008875:Middle Aged; D055414:Myocardial Perfusion Imaging / Q000379:methods*; D015203:Reproducibility of Results; D014057:Tomography, X-Ray Computed / Q000379:methods