The Incremental Diagnostic Performance of Coronary Computed Tomography Angiography Added to Myocardial Perfusion Imaging in Patients with Intermediate-to-High Cardiovascular Risk.
OBJECTIVE
Several studies have suggested that a combined approach of stress myocardial perfusion imaging (MPI) and coronary computed tomography angiography (CCTA) can provide diagnostic results with excellent accuracy. We aimed to explore whether the addition of CCTA to stress MPI provides incremental diagnostic value in intermediate-to-high cardiovascular risk patients.


METHODS
A total of 106 consecutive patients (93 male, 65 ± 10.4 years) underwent coronary artery calcium scoring (CACS), CCTA and (201)Thallium stress MPI before coronary angiography was reviewed. Thirty-seven patients (34.9%) had a history of proven coronary artery disease (CAD) or revascularization procedures, and four had documented non-significant CAD (3.8%). The remaining patients consisted of 17 (16.0%) classified as intermediate, and 48 (45.3%) as the high-risk groups.


RESULTS
Obstructive CAD was diagnosed by invasive coronary angiography in 88 patients with 161 vessels. The sensitivity and specificity in a patient-based analysis for obstructive CAD were 99% and 17% for CCTA, 80% and 50% for MPI and 91% and 67% for the combined method, respectively. The per-vessel diagnostic sensitivity and specificity were 95% and 54% for CCTA, 59% and 75% for MPI and 84% and 76% for the combined method. There were significant differences (p < 0.05) when comparing the combined method with MPI or CCTA by areas under the curve in a patient- or vessel-based analysis. However, CACS of 400 or more could not further stratify the patients with obstructive CAD.


CONCLUSIONS
CCTA, not CACS, provided additional diagnostic values to stress MPI in patients with intermediate-to-high cardiovascular risk.


BACKGROUND
Coronary artery disease (CAD) • Coronary computed tomography angiography (CCTA) • Myocardial perfusion imaging (MPI) • Single-photon emission computed tomography (SPECT).
Department of Nuclear Medicine, National Taiwan University Hospital Yun-Lin Branch, Yun-Lin;
Pei-Ying
PY
Hsu
Department of Medical Imaging;
Wen-Jeng
WJ
Lee
Department of Nuclear Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei;
Mei-Fang
MF
Cheng
Department of Nuclear Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei;
Ruoh-Fang
RF
Yen
Department of Nuclear Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei;
Kai-Yuan
KY
Tzen
Department of Nuclear Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei; ; Cardiology Division of Cardiovascular Medical Center and Department of Nuclear Medicine, Far Eastern Memorial Hospital, New Taipei City & National Yang-Ming University School of Medicine, Taipei, Taiwan.
Yen-Wen
YW
Wu