title: Computed tomography myocardial perfusion vs15O-water positron emission tomography and fractional flow reserve.
abstract: OBJECTIVE
  Computed tomography (CT) can perform comprehensive cardiac imaging. We compared CT coronary angiography (CTCA) and CT myocardial perfusion (CTP) with15O-water positron emission tomography (PET) and invasive coronary angiography (ICA) with fractional flow reserve (FFR).
  
  
  METHODS
  51 patients (63 (61-65) years, 80 % male) with known/suspected coronary artery disease (CAD) underwent 320-multidetector CTCA followed by "snapshot" adenosine stress CTP. Of these 22 underwent PET and 47 ICA/FFR. Obstructive CAD was defined as CTCA stenosis >50 % and CTP hypoperfusion, ICA stenosis >70 % or FFR <0.80.
  
  
  RESULTS
  PET hyperaemic myocardial blood flow (MBF) was lower in obstructive than non-obstructive territories defined by ICA/FFR (1.76 (1.32-2.20) vs 3.11 (2.44-3.79) mL/(g/min), P < 0.001) and CTCA/CTP (1.76 (1.32-2.20) vs 3.12 (2.44-3.79) mL/(g/min), P < 0.001). Baseline and hyperaemic CT attenuation density was lower in obstructive than non-obstructive territories (73 (71-76) vs 86 (84-88) HU, P < 0.001 and 101 (96-106) vs 111 (107-114) HU, P 0.001). PET hyperaemic MBF corrected for rate pressure product correlated with CT attenuation density (r = 0.579, P < 0.001). There was excellent per-patient sensitivity (96 %), specificity (85 %), negative predictive value (90 %) and positive predictive value (94 %) for CTCA/CTP vs ICA/FFR.
  
  
  CONCLUSIONS
  CT myocardial attenuation density correlates with15O-water PET MBF. CTCA and CTP can accurately identify obstructive CAD.
  
  
  CONCLUSIONS
  •CT myocardial perfusion can aid the assessment of suspected coronary artery disease. • CT attenuation density from "snapshot" imaging is a marker of myocardial perfusion. • CT myocardial attenuation density correlates with15O-water PET myocardial blood flow. • CT attenuation density is lower in obstructive territories defined by invasive angiography. • Diagnostic accuracy of CTCA+CTP is comparable to invasive angiography + fractional flow reserve.
authors.affiliation: University of Edinburgh/British Heart Foundation Centre for Cardiovascular Science, Chancellor's Building, 49 Little France Crescent, Edinburgh, UK, EH16 4SB. michelle.williams@ed.ac.uk.
authors.forename: Michelle C
authors.initials: MC
authors.lastname: Williams
authors.affiliation: Clinical Research Imaging Centre, University of Edinburgh, Edinburgh, UK.
authors.forename: Saeed
authors.initials: S
authors.lastname: Mirsadraee
authors.affiliation: University of Edinburgh/British Heart Foundation Centre for Cardiovascular Science, Chancellor's Building, 49 Little France Crescent, Edinburgh, UK, EH16 4SB.
authors.forename: Marc R
authors.initials: MR
authors.lastname: Dweck
authors.affiliation: Clinical Research Imaging Centre, University of Edinburgh, Edinburgh, UK.
authors.forename: Nicholas W
authors.initials: NW
authors.lastname: Weir
authors.affiliation: Clinical Research Imaging Centre, University of Edinburgh, Edinburgh, UK.
authors.forename: Alison
authors.initials: A
authors.lastname: Fletcher
authors.affiliation: Clinical Research Imaging Centre, University of Edinburgh, Edinburgh, UK.
authors.forename: Christophe
authors.initials: C
authors.lastname: Lucatelli
authors.affiliation: University of Edinburgh/British Heart Foundation Centre for Cardiovascular Science, Chancellor's Building, 49 Little France Crescent, Edinburgh, UK, EH16 4SB.|Clinical Research Imaging Centre, University of Edinburgh, Edinburgh, UK.
authors.forename: Tom
authors.initials: T
authors.lastname: MacGillivray
authors.affiliation: University of Edinburgh/British Heart Foundation Centre for Cardiovascular Science, Chancellor's Building, 49 Little France Crescent, Edinburgh, UK, EH16 4SB.
authors.forename: Saroj K
authors.initials: SK
authors.lastname: Golay
authors.affiliation: Edinburgh Heart Centre, Royal Infirmary of Edinburgh, Edinburgh, UK.
authors.forename: Nicholas L
authors.initials: NL
authors.lastname: Cruden
authors.affiliation: Edinburgh Heart Centre, Royal Infirmary of Edinburgh, Edinburgh, UK.
authors.forename: Peter A
authors.initials: PA
authors.lastname: Henriksen
authors.affiliation: Edinburgh Heart Centre, Royal Infirmary of Edinburgh, Edinburgh, UK.
authors.forename: Neal
authors.initials: N
authors.lastname: Uren
authors.affiliation: Department of Radiology, Royal Infirmary of Edinburgh, Edinburgh, UK.
authors.forename: Graham
authors.initials: G
authors.lastname: McKillop
authors.affiliation: Departments of Medicine and Radiology, Johns Hopkins Hospital, Baltimore, MD, USA.
authors.forename: João A C
authors.initials: JA
authors.lastname: Lima
authors.affiliation: Clinical Research Imaging Centre, University of Edinburgh, Edinburgh, UK.
authors.forename: John H
authors.initials: JH
authors.lastname: Reid
authors.affiliation: University of Edinburgh/British Heart Foundation Centre for Cardiovascular Science, Chancellor's Building, 49 Little France Crescent, Edinburgh, UK, EH16 4SB.|Clinical Research Imaging Centre, University of Edinburgh, Edinburgh, UK.
authors.forename: Edwin J R
authors.initials: EJ
authors.lastname: van Beek
authors.affiliation: Department of Radiology, Royal Infirmary of Edinburgh, Edinburgh, UK.
authors.forename: Dilip
authors.initials: D
authors.lastname: Patel
authors.affiliation: University of Edinburgh/British Heart Foundation Centre for Cardiovascular Science, Chancellor's Building, 49 Little France Crescent, Edinburgh, UK, EH16 4SB.|Clinical Research Imaging Centre, University of Edinburgh, Edinburgh, UK.
authors.forename: David E
authors.initials: DE
authors.lastname: Newby
mesh_terms: D000241:Adenosine; D000368:Aged; D000072226:Computed Tomography Angiography / Q000379:methods; D017023:Coronary Angiography / Q000379:methods; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging*; D023921:Coronary Stenosis / Q000000981:diagnostic imaging*; D005080:Exercise Test; D005260:Female; D053805:Fractional Flow Reserve, Myocardial; D006801:Humans; D008297:Male; D008875:Middle Aged; D055414:Myocardial Perfusion Imaging / Q000379:methods*; D010104:Oxygen Radioisotopes; D049268:Positron-Emission Tomography / Q000379:methods; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000379:methods; D014665:Vasodilator Agents; D014867:Water
chemical_list: D010104:Oxygen Radioisotopes; D014665:Vasodilator Agents; D014867:Water; D000241:Adenosine
keywords: Angina; Angiography; Imaging; Ischaemia; Perfusion