Korean Journal of Radiology

The Korean Society of Radiology (대한영상의학회)
권호 표지
DOI QR코드

DOI QR Code

Diagnostic Performance of Coronary CT Angiography, Stress Dual-Energy CT Perfusion, and Stress Perfusion Single-Photon Emission Computed Tomography for Coronary Artery Disease: Comparison with Combined Invasive Coronary Angiography and Stress Perfusion Cardiac MRI

  • Chung, Hyun Woo (Department of Nuclear Medicine, Konkuk University Medical Center, Research Institute of Biomedical Science, Konkuk University School of Medicine) ;
  • Ko, Sung Min (Department of Radiology, Konkuk University Medical Center, Research Institute of Biomedical Science, Konkuk University School of Medicine) ;
  • Hwang, Hweung Kon (Department of Internal Medicine, Division of Cardiology, Konkuk University Medical Center, Konkuk University School of Medicine) ;
  • So, Young (Department of Nuclear Medicine, Konkuk University Medical Center, Research Institute of Biomedical Science, Konkuk University School of Medicine) ;
  • Yi, Jeong Geun (Department of Radiology, Konkuk University Medical Center, Research Institute of Biomedical Science, Konkuk University School of Medicine) ;
  • Lee, Eun Jeong (Department of Nuclear Medicine, Seoul Medical Center)
  • Received : 2016.02.23
  • Accepted : 2016.09.07
  • Published : 2017.06.01
⟨ Previous Next ⟩

Abstract

Objective: To investigate the diagnostic performance of coronary computed tomography angiography (CCTA), stress dualenergy computed tomography perfusion (DE-CTP), stress perfusion single-photon emission computed tomography (SPECT), and the combinations of CCTA with myocardial perfusion imaging (CCTA + DE-CTP and CCTA + SPECT) for identifying coronary artery stenosis that causes myocardial hypoperfusion. Combined invasive coronary angiography (ICA) and stress perfusion cardiac magnetic resonance (SP-CMR) imaging are used as the reference standard. Materials and Methods: We retrospectively reviewed the records of 25 patients with suspected coronary artery disease, who underwent CCTA, DE-CTP, SPECT, SP-CMR, and ICA. The reference standard was defined as ${\geq}50%$ stenosis by ICA, with a corresponding myocardial hypoperfusion on SP-CMR. Results: For per-vascular territory analysis, the sensitivities of CCTA, DE-CTP, SPECT, CCTA + DE-CTP, and CCTA + SPECT were 96, 96, 68, 93, and 68%, respectively, and specificities were 72, 75, 89, 85, and 94%, respectively. The areas under the receiver operating characteristic curve (AUCs) were $0.84{\pm}0.05$, $0.85{\pm}0.05$, $0.79{\pm}0.06$, $0.89{\pm}0.04$, and $0.81{\pm}0.06$, respectively. For per-patient analysis, the sensitivities of CCTA, DE-CTP, SPECT, CCTA + DE-CTP, and CCTA + SPECT were 100, 100, 89, 100, and 83%, respectively; the specificities were 14, 43, 57, 43, and 57%, respectively; and the AUCs were $0.57{\pm}0.13$, $0.71{\pm}0.11$, $0.73{\pm}0.11$, $0.71{\pm}0.11$, and $0.70{\pm}0.11$, respectively. Conclusion: The combination of CCTA and DE-CTP enhances specificity without a loss of sensitivity for detecting hemodynamically significant coronary artery stenosis, as defined by combined ICA and SP-CMR.

Keywords

References

  1. Go AS, Mozaffarian D, Roger VL, Benjamin EJ, Berry JD, Borden WB, et al. Heart disease and stroke statistics--2013 update: a report from the American Heart Association. Circulation 2013;127:e6-e245
  2. Mowatt G, Cummins E, Waugh N, Walker S, Cook J, Jia X, et al. Systematic review of the clinical effectiveness and costeffectiveness of 64-slice or higher computed tomography angiography as an alternative to invasive coronary angiography in the investigation of coronary artery disease. Health Technol Assess 2008;12:iii-iv, ix-143
  3. Litt HI, Gatsonis C, Snyder B, Singh H, Miller CD, Entrikin DW, et al. CT angiography for safe discharge of patients with possible acute coronary syndromes. N Engl J Med 2012;366:1393-1403 https://doi.org/10.1056/NEJMoa1201163
  4. Gaemperli O, Schepis T, Valenta I, Koepfli P, Husmann L, Scheffel H, et al. Functionally relevant coronary artery disease: comparison of 64-section CT angiography with myocardial perfusion SPECT. Radiology 2008;248:414-423 https://doi.org/10.1148/radiol.2482071307
  5. Yoon YE, Lim TH. Current roles and future applications of cardiac CT: risk stratification of coronary artery disease. Korean J Radiol 2014;15:4-11 https://doi.org/10.3348/kjr.2014.15.1.4
  6. Mowatt G, Vale L, Brazzelli M, Hernandez R, Murray A, Scott N, et al. Systematic review of the effectiveness and costeffectiveness, and economic evaluation, of myocardial perfusion scintigraphy for the diagnosis and management of angina and myocardial infarction. Health Technol Assess 2004;8:iii-iv, 1-207
  7. Lee WW, So Y, Kim KB, Lee DS. Impaired coronary flow reserve is the most important marker of viable myocardium in the myocardial segment-based analysis of dual-isotope gated myocardial perfusion single-photon emission computed tomography. Korean J Radiol 2014;15:277-285 https://doi.org/10.3348/kjr.2014.15.2.277
  8. Singh H, Patel CD, Mishra S, Bhargava B. Stress-rest thallium-201 myocardial perfusion SPECT pattern in patients with exercise induced left bundle branch block. Nucl Med Mol Imaging 2014;48:251-254 https://doi.org/10.1007/s13139-014-0267-3
  9. Varga-Szemes A, Meinel FG, De Cecco CN, Fuller SR, Bayer RR 2nd, Schoepf UJ. CT myocardial perfusion imaging. AJR Am J Roentgenol 2015;204:487-497 https://doi.org/10.2214/AJR.14.13546
  10. Tonino PA, De Bruyne B, Pijls NH, Siebert U, Ikeno F, van' t Veer M, et al. Fractional flow reserve versus angiography for guiding percutaneous coronary intervention. N Engl J Med 2009;360:213-224 https://doi.org/10.1056/NEJMoa0807611
  11. De Bruyne B, Pijls NH, Kalesan B, Barbato E, Tonino PA, Piroth Z, et al. Fractional flow reserve-guided PCI versus medical therapy in stable coronary disease. N Engl J Med 2012;367:991-1001 https://doi.org/10.1056/NEJMoa1205361
  12. van Nunen LX, Zimmermann FM, Tonino PA, Barbato E, Baumbach A, Engstrom T, et al. Fractional flow reserve versus angiography for guidance of PCI in patients with multivessel coronary artery disease (FAME): 5-year follow-up of a randomised controlled trial. Lancet 2015;386:1853-1860 https://doi.org/10.1016/S0140-6736(15)00057-4
  13. Greenwood JP, Maredia N, Younger JF, Brown JM, Nixon J, Everett CC, et al. Cardiovascular magnetic resonance and single-photon emission computed tomography for diagnosis of coronary heart disease (CE-MARC): a prospective trial. Lancet 2012;379:453-460 https://doi.org/10.1016/S0140-6736(11)61335-4
  14. Yoon YE, Hong YJ, Kim HK, Kim JA, Na JO, Yang DH, et al. 2014 Korean guidelines for appropriate utilization of cardiovascular magnetic resonance imaging: a joint report of the Korean Society of Cardiology and the Korean Society of Radiology. Korean J Radiol 2014;15:659-688 https://doi.org/10.3348/kjr.2014.15.6.659
  15. Desai RR, Jha S. Diagnostic performance of cardiac stress perfusion MRI in the detection of coronary artery disease using fractional flow reserve as the reference standard: a meta-analysis. AJR Am J Roentgenol 2013;201:W245-W252 https://doi.org/10.2214/AJR.12.10002
  16. Li M, Zhou T, Yang LF, Peng ZH, Ding J, Sun G. Diagnostic accuracy of myocardial magnetic resonance perfusion to diagnose ischemic stenosis with fractional flow reserve as reference: systematic review and meta-analysis. JACC Cardiovasc Imaging 2014;7:1098-1105 https://doi.org/10.1016/j.jcmg.2014.07.011
  17. Hausleiter J, Meyer T, Hermann F, Hadamitzky M, Krebs M, Gerber TC, et al. Estimated radiation dose associated with cardiac CT angiography. JAMA 2009;301:500-507 https://doi.org/10.1001/jama.2009.54
  18. Patel MR, Peterson ED, Dai D, Brennan JM, Redberg RF, Anderson HV, et al. Low diagnostic yield of elective coronary angiography. N Engl J Med 2010;362:886-895 https://doi.org/10.1056/NEJMoa0907272
  19. Pfisterer M, Brunner-La Rocca HP, Buser PT, Rickenbacher P, Hunziker P, Mueller C, et al. Late clinical events after clopidogrel discontinuation may limit the benefit of drugeluting stents: an observational study of drug-eluting versus bare-metal stents. J Am Coll Cardiol 2006;48:2584-2591 https://doi.org/10.1016/j.jacc.2006.10.026
  20. Knaapen P, Camici PG, Marques KM, Nijveldt R, Bax JJ, Westerhof N, et al. Coronary microvascular resistance: methods for its quantification in humans. Basic Res Cardiol 2009;104:485-498 https://doi.org/10.1007/s00395-009-0037-z
  21. Ko SM, Park JH, Hwang HK, Song MG. Direct comparison of stress- and rest-dual-energy computed tomography for detection of myocardial perfusion defect. Int J Cardiovasc Imaging 2014;30 Suppl 1:41-53 https://doi.org/10.1007/s10554-014-0410-3
  22. Schwarz F, Ruzsics B, Schoepf UJ, Bastarrika G, Chiaramida SA, Abro JA, et al. Dual-energy CT of the heart--principles and protocols. Eur J Radiol 2008;68:423-433 https://doi.org/10.1016/j.ejrad.2008.09.010
  23. Ko SM, Choi JW, Song MG, Shin JK, Chee HK, Chung HW, et al. Myocardial perfusion imaging using adenosine-induced stress dual-energy computed tomography of the heart: comparison with cardiac magnetic resonance imaging and conventional coronary angiography. Eur Radiol 2011;21:26-35 https://doi.org/10.1007/s00330-010-1897-1
  24. Ko SM, Choi JW, Hwang HK, Song MG, Shin JK, Chee HK. Diagnostic performance of combined noninvasive anatomic and functional assessment with dual-source CT and adenosineinduced stress dual-energy CT for detection of significant coronary stenosis. AJR Am J Roentgenol 2012;198:512-520 https://doi.org/10.2214/AJR.11.7029
  25. Lima RS, Watson DD, Goode AR, Siadaty MS, Ragosta M, Beller GA, et al. Incremental value of combined perfusion and function over perfusion alone by gated SPECT myocardial perfusion imaging for detection of severe three-vessel coronary artery disease. J Am Coll Cardiol 2003;42:64-70 https://doi.org/10.1016/S0735-1097(03)00562-X
  26. Wagner A, Mahrholdt H, Holly TA, Elliott MD, Regenfus M, Parker M, et al. Contrast-enhanced MRI and routine single photon emission computed tomography (SPECT) perfusion imaging for detection of subendocardial myocardial infarcts: an imaging study. Lancet 2003;361:374-379 https://doi.org/10.1016/S0140-6736(03)12389-6
  27. Mouden M, Timmer JR, Ottervanger JP, Reiffers S, Oostdijk AH, Knollema S, et al. Impact of a new ultrafast CZT SPECT camera for myocardial perfusion imaging: fewer equivocal results and lower radiation dose. Eur J Nucl Med Mol Imaging 2012;39:1048-1055 https://doi.org/10.1007/s00259-012-2086-z
  28. Ben Bouallegue F, Roubille F, Lattuca B, Cung TT, Macia JC, Gervasoni R, et al. SPECT myocardial perfusion reserve in patients with multivessel coronary disease: correlation with angiographic findings and invasive fractional flow reserve measurements. J Nucl Med 2015;56:1712-1717 https://doi.org/10.2967/jnumed.114.143164
  29. Rief M, Zimmermann E, Stenzel F, Martus P, Stangl K, Greupner J, et al. Computed tomography angiography and myocardial computed tomography perfusion in patients with coronary stents: prospective intraindividual comparison with conventional coronary angiography. J Am Coll Cardiol 2013;62:1476-1485 https://doi.org/10.1016/j.jacc.2013.03.088
  30. Kim YJ, Yong HS, Kim SM, Kim JA, Yang DH, Hong YJ. Guideline for appropriate use of cardiac CT in heart disease. J Korean Soc Radiol 2014;70:93-109 https://doi.org/10.3348/jksr.2014.70.2.93
  31. Prompona M, Cyran C, Nikolaou K, Bauner K, Reiser M, Huber A. Contrast-enhanced whole-heart coronary MRA using Gadofosveset 3.0 T versus 1.5 T. Acad Radiol 2010;17:862-870 https://doi.org/10.1016/j.acra.2010.02.009

Cited by

  1. A Glimpse on Trends and Characteristics of Recent Articles Published in the Korean Journal of Radiology vol.20, pp.12, 2019, https://doi.org/10.3348/kjr.2019.0928
  2. Simplified Bernoulli Formula to Diagnose Ischemia-Causing Stenosis at Coronary CT Angiography: Comparison with SPECT vol.8, pp.2, 2017, https://doi.org/10.4236/act.2019.82002
  3. Cardiac Computed Tomography Perfusion: Contrast Agents, Challenges and Emerging Methodologies from Preclinical Research to the Clinics vol.28, pp.1, 2017, https://doi.org/10.1016/j.acra.2019.12.026