title: Enhanced diagnostic utility achieved by myocardial blood analysis: A meta-analysis of noninvasive cardiac imaging in the detection of functional coronary artery disease.
abstract: OBJECTIVE
  The aim of this study is to determine the diagnostic utility of 6 cardiac imaging modalities using fractional flow reserve (FFR) as the reference standard.
  
  
  METHODS
  Studies reporting diagnostic performance of computed tomographic perfusion imaging (CTP), fractional flow reserve derived from computed tomography (FFRCT), cardiac magnetic resonance (CMR), positron emission tomography (PET), single-photon emission computed tomography (SPECT) and dobutamine stress echocardiography (DSE) for diagnosis of ischemia-causing lesions were included.
  
  
  RESULTS
  On vessel-based and patient-based analyses, CMR, PET, CTP and FFRCT exhibited comparable sensitivity (per-vessel: 87% vs. 86% vs. 89% vs. 86%; per-patient: 88% vs. 90% vs. 88% vs. 90%, P>0.05) and specificity (per-vessel: 89% vs. 88% vs. 89% vs. 83%; per-patient: 84% vs. 84% vs. 87% vs. 75%, P>0.05); whereas SPECT yielded significantly lower sensitivity (per-vessel: 72%; per-patient: 78%, P<0.05) and specificity (per-vessel: 79%; per-patient: 79%, P<0.05) and DES yielded significantly lower sensitivity (per-vessel: 62%, per-patient: 69%, P<0.05). On the other hand, within the same imaging modality, myocardial blood flow (MBF) derived by CTP had a higher sensitivity (90% vs. 80%, P=0.048) but lower specificity (77% vs. 93%, P=0.02) than that of perfusion defect (PD). Moreover, MBF derived by CMR had a lower specificity than that of PD (60% vs. 93%, P=0.02), while coronary flow reserve (CRF) derived by PET had a lower specificity than that of MBF (81% vs. 89%, P=0.005).
  
  
  CONCLUSIONS
  CMR, PET, CTP and FFRCT expressed similar and high accuracy in detecting functional CAD, whereas different analysis methods for each imaging modality may vary their diagnostic utility.
authors.affiliation: Cardiology Department, Tenth People's Hospital of Tongji University, Shanghai, China; Center for Systems Biology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
authors.forename: Neng
authors.initials: N
authors.lastname: Dai
authors.affiliation: Cardiology Department, Tenth People's Hospital of Tongji University, Shanghai, China.
authors.forename: Xianlin
authors.initials: X
authors.lastname: Zhang
authors.affiliation: Cardiology Department, Tenth People's Hospital of Tongji University, Shanghai, China.
authors.forename: Yi
authors.initials: Y
authors.lastname: Zhang
authors.affiliation: Cardiology Department, Tenth People's Hospital of Tongji University, Shanghai, China.
authors.forename: Lei
authors.initials: L
authors.lastname: Hou
authors.affiliation: Cardiology Department, Tenth People's Hospital of Tongji University, Shanghai, China.
authors.forename: WeiMing
authors.initials: W
authors.lastname: Li
authors.affiliation: Cardiology Department, ZhongShan Hospital of Fudan University, Shanghai, China. Electronic address: fanbingzs@126.com.
authors.forename: Bing
authors.initials: B
authors.lastname: Fan
authors.affiliation: Department of TCM, Jing'An District Centre Hospital, Shanghai, China. Electronic address: ztsdoctor@126.com.
authors.forename: TianSong
authors.initials: T
authors.lastname: Zhang
authors.affiliation: Cardiology Department, Tenth People's Hospital of Tongji University, Shanghai, China. Electronic address: xuyaweish@aliyun.com.
authors.forename: YaWei
authors.initials: Y
authors.lastname: Xu
mesh_terms: D055426:Cardiac-Gated Single-Photon Emission Computer-Assisted Tomography / Q000379:methods; D017023:Coronary Angiography / Q000379:methods; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D025401:Echocardiography, Stress / Q000379:methods; D053805:Fractional Flow Reserve, Myocardial / Q000502:physiology*; D006801:Humans; D019028:Magnetic Resonance Imaging, Cine / Q000379:methods; D055414:Myocardial Perfusion Imaging / Q000379:methods; D049268:Positron-Emission Tomography / Q000379:methods
keywords: Cardiac imaging; Coronary artery disease; Fractional flow reserve; Noninvasive imaging