title: Diagnostic accuracy of static CT perfusion for the detection of myocardial ischemia. A systematic review and meta-analysis.
abstract: OBJECTIVE
  The aim of this study is to provide a meta-analysis of all published studies assessing the diagnostic accuracy of stress CT myocardial perfusion imaging (CTP) in patients suspected of or with known coronary artery disease. This analysis is limited to static stress CTP.
  
  
  METHODS
  Systematic literature review and meta-analysis of studies examining the diagnostic accuracy of static CTP imaging alone or combined with coronary CT angiography (CTA) in comparison to single photon emission computed tomography (SPECT), magnetic resonance perfusion (MRP), and/or invasive coronary angiography with and without fractional flow reserve (FFR).
  
  
  RESULTS
  The search revealed 19 eligible studies including 1188 patients. Pooled results showed that CTP had a good agreement with SPECT and MRP. On a per-patient level, sensitivity, specificity and AUC were 0.85 (95% CI: 0.70-0.93), 0.81 (95% CI: 0.59-0.93), 0.90 (95% CI: 0.87-0.92). On a per-artery level, sensitivity, specificity and AUC were 0.80 (95% CI: 0.67-0.88), 0.81 (95% CI: 0.72-0.88) and 0.87 (95% CI: 0.84-0.90). When invasive coronary angiography was used as reference standard, combined coronary CTA and CTP compared to coronary CTA alone significantly improved the specificity from 0.62 (95% CI: 0.52-0.70) to 0.84 (95% CI: 0.74-0.91) on a per-patient level (p = 0.008) and from 0.72 (95% CI: 0.63-0.79) to 0.90 (95% CI: 0.85-0.93) on a per-artery level (p = 0.0001) without significant decrease in sensitivity (p = 0.59 and p = 0.23, respectively).
  
  
  CONCLUSIONS
  In selected patients, static CT myocardial perfusion has high diagnostic accuracy to detecting myocardial ischemia. Specificity increases significantly when CT myocardial perfusion is combined with coronary CTA.
authors: Department of Cardiology, The Heart Centre, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100 Copenhagen-Ø, Denmark. Electronic address: mathiassoergaard@hotmail.com.
authors: Mathias Holm
authors: MH
authors: Sørgaard
authors: Department of Cardiology, The Heart Centre, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100 Copenhagen-Ø, Denmark; Department of Radiology, The Diagnostic Centre, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100 Copenhagen-Ø, Denmark. Electronic address: kkofoed@dadlnet.dk.
authors: Klaus Fuglsang
authors: KF
authors: Kofoed
authors: Department of Cardiology, The Heart Centre, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100 Copenhagen-Ø, Denmark. Electronic address: jesper_linde@hotmail.com.
authors: Jesper James
authors: JJ
authors: Linde
authors: Department of Medicine, Division of Cardiology, John Hopkins University School of Medicine, 600 N. Wolfe Street, Blalock 524, Baltimore, USA. Electronic address: georgeri@medimmune.com.
authors: Richard Thomas
authors: RT
authors: George
authors: Heart Institute, Incor, University of São Paulo Medical School, Avenida Dr. Eneas de Carvalho Aguiar, 44 - Pinheiros, São Paulo, SP 05403-900, Brazil. Electronic address: rochitte@gmail.com.
authors: Carlos Eduardo
authors: CE
authors: Rochitte
authors: Medical University Innsbruck, Department of Radiology, Innrain 52, Christoph-Probst-Platz, 6020 Innsbruck, Austria. Electronic address: Gudrun.feuchtner@gmail.com.
authors: Gudrun
authors: G
authors: Feuchtner
authors: Department of Medicine, Division of Cardiology, John Hopkins University School of Medicine, 600 N. Wolfe Street, Blalock 524, Baltimore, USA. Electronic address: jlima@jhmi.edu.
authors: Joao A C
authors: JA
authors: Lima
authors: Department of Medicine, Division of Cardiology, Glostrup University Hospital, Nordre Ringvej 57, 2600 Glostrup, Denmark. Electronic address: jawab@dadlnet.dk.
authors: Jawdat
authors: J
authors: Abdulla
mesh_terms: D000368:Aged; D019540:Area Under Curve; D000072226:Computed Tomography Angiography; D017023:Coronary Angiography; D003326:Coronary Circulation; D003331:Coronary Vessels / Q000000981:diagnostic imaging* / Q000503:physiopathology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography; D017202:Myocardial Ischemia / Q000000981:diagnostic imaging* / Q000503:physiopathology; D055414:Myocardial Perfusion Imaging / Q000379:methods*; D011237:Predictive Value of Tests; D012372:ROC Curve; D015203:Reproducibility of Results
keywords: Computed tomography perfusion; Coronary artery disease; Coronary computed tomography angiography; Fractional flow reserve; Invasive coronary angiography; Magnetic resonance perfusion; Meta-analysis; Single photon emission computed tomography; Stress myocardial perfusion