title: Combined Quantitative Assessment of Myocardial Perfusion and Coronary Artery Calcium Score by Hybrid 82Rb PET/CT Improves Detection of Coronary Artery Disease.
abstract: Hybrid PET myocardial perfusion imaging (MPI) with CT allows the incorporation of coronary artery calcium (CAC) into the clinical protocol. We aimed to determine whether the combined analysis of MPI and CAC could improve the diagnostic accuracy of PET MPI in detection of obstructive coronary artery disease (CAD).
  
  
  METHODS
  Consecutive patients (n = 152; mean age ± SD, 69 ± 12 y) without prior CAD, referred to (82)Rb PET MPI followed by invasive coronary angiography performed within 14 days, were studied. Myocardial perfusion was quantified automatically for left anterior descending, left circumflex, and right coronary artery territories as an ischemic total perfusion deficit (ITPD) for 456 vessels. Global and per-vessel CAC Agatston scores were calculated. Obstructive CAD was defined as 50% or greater stenosis of the left main and 70% or greater stenosis in the left anterior descending, left circumflex, and right coronary arteries. Logistic regression and 10-fold cross validation were used to derive and validate the combined ITPD/logCAC (logarithm of coronary calcium) scores.
  
  
  RESULTS
  In the prediction of per-vessel obstructive CAD, the receiver-operating-characteristic area under the curve for combined per-vessel ITPD/logCAC score was higher, 0.85 (95% confidence interval [CI], 0.81-0.89), than standalone ITPD area under the curve, 0.81 (95% CI: 0.76-0.85), and logCAC score, 0.73 (95% CI, 0.68-0.78; P < 0.05). The integrated discrimination improvement of combined per-vessel ITPD/logCAC analysis was 0.07 (95% CI, 0.04-0.09; P < 0.0001), as compared with ITPD alone.
  
  
  CONCLUSIONS
  Combined automatically derived per-vessel ITPD and logCAC score improves accuracy of (82)Rb PET MPI for detection of obstructive CAD.
authors.affiliation: Department of Imaging, Cedars-Sinai Medical Center, Los Angeles, California.
authors.forename: Yafim
authors.initials: Y
authors.lastname: Brodov
authors.affiliation: Department of Imaging, Cedars-Sinai Medical Center, Los Angeles, California.
authors.forename: Heidi
authors.initials: H
authors.lastname: Gransar
authors.affiliation: Department of Imaging, Cedars-Sinai Medical Center, Los Angeles, California David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California; and.
authors.forename: Damini
authors.initials: D
authors.lastname: Dey
authors.affiliation: Department of Imaging, Cedars-Sinai Medical Center, Los Angeles, California.
authors.forename: Aryeh
authors.initials: A
authors.lastname: Shalev
authors.affiliation: Department of Imaging, Cedars-Sinai Medical Center, Los Angeles, California David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California; and.
authors.forename: Guido
authors.initials: G
authors.lastname: Germano
authors.affiliation: Department of Imaging, Cedars-Sinai Medical Center, Los Angeles, California.
authors.forename: John D
authors.initials: JD
authors.lastname: Friedman
authors.affiliation: Department of Imaging, Cedars-Sinai Medical Center, Los Angeles, California.
authors.forename: Sean W
authors.initials: SW
authors.lastname: Hayes
authors.affiliation: Department of Imaging, Cedars-Sinai Medical Center, Los Angeles, California.
authors.forename: Louise E J
authors.initials: LE
authors.lastname: Thomson
authors.affiliation: Samuel Oschin Comprehensive Cancer Institute, Los Angeles, California.
authors.forename: André
authors.initials: A
authors.lastname: Rogatko
authors.affiliation: Department of Imaging, Cedars-Sinai Medical Center, Los Angeles, California David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California; and.
authors.forename: Daniel S
authors.initials: DS
authors.lastname: Berman
authors.affiliation: Department of Imaging, Cedars-Sinai Medical Center, Los Angeles, California David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California; and piotr.slomka@cshs.org.
authors.forename: Piotr J
authors.initials: PJ
authors.lastname: Slomka
mesh_terms: D000368:Aged; D000465:Algorithms; D002114:Calcinosis / Q000175:diagnosis*; D023921:Coronary Stenosis / Q000175:diagnosis*; D005260:Female; D006801:Humans; D007089:Image Enhancement / Q000379:methods; D007090:Image Interpretation, Computer-Assisted / Q000379:methods; D008297:Male; D064847:Multimodal Imaging / Q000379:methods; D055414:Myocardial Perfusion Imaging / Q000379:methods*; D049268:Positron-Emission Tomography / Q000379:methods*; D019275:Radiopharmaceuticals; D015203:Reproducibility of Results; D012414:Rubidium Radioisotopes; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000379:methods*
chemical_list: D019275:Radiopharmaceuticals; D012414:Rubidium Radioisotopes
keywords: coronary calcium score; detection of obstructive coronary artery disease; hybrid cardiac positron emission tomography