title: Diagnostic advantage of stress computed tomography myocardial perfusion over single-photon emission computed tomography for the assessment of myocardial ischemia.
abstract: BACKGROUND
  This study compared adenosine stress computed tomography myocardial perfusion (CTP) with single-photon emission computed tomography (SPECT) in the diagnosis of functionally significant coronary artery stenosis using fractional flow reserve (FFR) as reference standard.
  
  
  METHODS
  We included a total of 93 coronary arteries from 31 patients in whom at least one vessel with ≥50% stenosis was detected with computed tomography coronary angiography. All patients underwent both SPECT and adenosine stress CTP, followed by invasive coronary angiography (ICA) and FFR. Diagnostic accuracy between CTP and SPECT was compared according to positive findings of either ≥99% stenosis on ICA or FFR ≤0.8.
  
  
  RESULTS
  Among 78 vessels eligible for the quantitative analyses, significant coronary artery disease (CAD) was diagnosed in 22 vessels of 19 patients. Comparison of CTP vs. SPECT for sensitivity, specificity, positive predictive value (PPV), negative predictive value, and accuracy in detecting significant CAD were 59% vs. 18%, 96% vs. 93%, 87% vs. 50%, 86% vs. 74%, and 86% vs. 72%, respectively.
  
  
  CONCLUSIONS
  CTP demonstrated a significant diagnostic advantage over SPECT in the identification of significant CAD, especially in terms of sensitivity and PPV. Adenosine stress CTP is useful for the noninvasive diagnosis of functionally significant CAD.
authors.affiliation: Department of Cardiovascular Medicine, Aizawa Hospital, 2-5-1 Honjo, Matsumoto, Nagano 390-8510, Japan; Department of Cardiovascular Medicine, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano 390-8621, Japan.
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Ueki
authors.affiliation: Department of Cardiovascular Medicine, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano 390-8621, Japan; Shinshu University School of Health Sciences, 3-1-1 Asahi, Matsumoto, Nagano 390-8621, Japan. Electronic address: izawa611@shinshu-u.ac.jp.
authors.forename: Atsushi
authors.initials: A
authors.lastname: Izawa
authors.affiliation: Department of Cardiovascular Medicine, Aizawa Hospital, 2-5-1 Honjo, Matsumoto, Nagano 390-8510, Japan.
authors.forename: Daisuke
authors.initials: D
authors.lastname: Kashiwagi
authors.affiliation: Department of Cardiovascular Medicine, Aizawa Hospital, 2-5-1 Honjo, Matsumoto, Nagano 390-8510, Japan.
authors.forename: Shigeki
authors.initials: S
authors.lastname: Nishiyama
authors.affiliation: Department of Cardiovascular Medicine, Aizawa Hospital, 2-5-1 Honjo, Matsumoto, Nagano 390-8510, Japan.
authors.forename: Shinichi
authors.initials: S
authors.lastname: Aso
authors.affiliation: Department of Cardiovascular Medicine, Aizawa Hospital, 2-5-1 Honjo, Matsumoto, Nagano 390-8510, Japan.
authors.forename: Chihiro
authors.initials: C
authors.lastname: Suzuki
authors.affiliation: Department of Cardiovascular Medicine, Aizawa Hospital, 2-5-1 Honjo, Matsumoto, Nagano 390-8510, Japan.
authors.forename: Shumpei
authors.initials: S
authors.lastname: Sakurai
authors.affiliation: Department of Radiology, Aizawa Hospital, 2-5-1 Honjo, Matsumoto, Nagano 390-8510, Japan.
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Oguchi
authors.affiliation: Department of Cardiovascular Medicine, National Matsumoto Medical Center, 2-20-30 Muraicho-Minami, Matsumoto, Nagano 399-8701, Japan.
authors.forename: Yoshikazu
authors.initials: Y
authors.lastname: Yazaki
authors.affiliation: Department of Cardiovascular Medicine, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano 390-8621, Japan.
authors.forename: Uichi
authors.initials: U
authors.lastname: Ikeda
authors.affiliation: Department of Cardiovascular Medicine, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano 390-8621, Japan.
authors.forename: Koichiro
authors.initials: K
authors.lastname: Kuwahara
mesh_terms: D000368:Aged; D005260:Female; D053805:Fractional Flow Reserve, Myocardial; D006801:Humans; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000000981:diagnostic imaging* / Q000503:physiopathology; D055414:Myocardial Perfusion Imaging / Q000379:methods*; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000379:methods*
keywords: Computed tomography; Coronary angiography; Fractional flow reserve; Single-photon emission-computed tomography