title: Segmental quantitative myocardial perfusion with PET for the detection of significant coronary artery disease in patients with stable angina.
abstract: OBJECTIVE
  The goal of this study is to determine the technical accuracy of segmental perfusion parameters assessed with quantitative cardiac PET imaging in the evaluation of coronary artery disease (CAD) in patients with stable angina.
  
  
  METHODS
  A cohort of patients who participated in the EVINCI protocol underwent an evaluation of coronary anatomy by invasive coronary angiography (ICA) and/or coronary computed tomography angiography (CCTA) and PET myocardial perfusion imaging with H2 (15)O, (13)NH3 or (82)Rb. PET studies were analyzed by two independent observers blinded to clinical and instrumental data, and classified as positive or negative for significant CAD using only segmental perfusion measurements and cut-off values from literature.
  
  
  RESULTS
  On a per-patient basis, the overall inter-observer agreement on PET results was 90 % (kappa = 0.79), indicating substantial agreement. On a per-vessel basis, the inter-observer agreement on PET results was 88 % (kappa = 0.74) in the RCA territory, 94 % (kappa = 0.84) in the LAD territory and 94 % (kappa = 0.85) in the LCX territory. Segmental PET measurements correctly identified 85 % of the patients, resulting in a global sensitivity of 86 %, a specificity of 84 %, a positive predictive value (PPV) of 69 % and a negative predictive value (NPV) of 93 %. In vessel-based analyses, quantitative perfusion parameters had a sensitivity, specificity, PPV and NPV of 92 %, 82 %, 42 % and 99 %, respectively, for the detection of significant coronary stenoses in all major coronary arteries.
  
  
  CONCLUSIONS
  The assessment of absolute myocardial perfusion parameters measured at a segment level lead to reliable and accurate identification of patients with significant coronary stenosis at ICA and/or CCTA.
authors.affiliation: Department of Biomedical, Experimental and Clinical Sciences "Mario Serio", Nuclear Medicine Unit, University of Florence, Largo Brambilla 3, 50134, Florence, FI, Italy. valentina.berti@unifi.it.
authors.forename: Valentina
authors.identifier: http://orcid.org/0000-0001-9947-6559
authors.initials: V
authors.lastname: Berti
authors.affiliation: Department of Biomedical, Experimental and Clinical Sciences "Mario Serio", Nuclear Medicine Unit, University of Florence, Largo Brambilla 3, 50134, Florence, FI, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Sciagrà
authors.affiliation: Institute of Clinical Physiology, CNR, Pisa, Italy.
authors.forename: Danilo
authors.initials: D
authors.lastname: Neglia
authors.affiliation: Heart Center and Turku PET Center University of Turku and Turku University Hospital, Turku, Finland.
authors.forename: Mikko
authors.initials: M
authors.lastname: Pietilä
authors.affiliation: Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Arthur J
authors.initials: AJ
authors.lastname: Scholte
authors.affiliation: Nuklearmedizinische Klinik, Technische University of Munich, Munich, Germany.
authors.forename: Stephan
authors.initials: S
authors.lastname: Nekolla
authors.affiliation: Department of Nuclear Medicine, Bichat University Hospital, University Paris Diderot, Paris, France.
authors.forename: François
authors.initials: F
authors.lastname: Rouzet
authors.affiliation: Department of Biomedical, Experimental and Clinical Sciences "Mario Serio", Nuclear Medicine Unit, University of Florence, Largo Brambilla 3, 50134, Florence, FI, Italy.
authors.forename: Alberto
authors.initials: A
authors.lastname: Pupi
authors.affiliation: Heart Center and Turku PET Center University of Turku and Turku University Hospital, Turku, Finland.
authors.forename: Juhani
authors.initials: J
authors.lastname: Knuuti
mesh_terms: D060050:Angina, Stable / Q000150:complications*; D003324:Coronary Artery Disease / Q000150:complications* / Q000000981:diagnostic imaging* / Q000503:physiopathology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D055414:Myocardial Perfusion Imaging; D015588:Observer Variation; D049268:Positron-Emission Tomography; D012680:Sensitivity and Specificity
keywords: Absolute quantification; Accuracy; Cardiac PET; Myocardial perfusion imaging; Reproducibility