TY - JOUR
T1 - Combined coronary angiography and myocardial perfusion by computed tomography in the identification of flow-limiting stenosis - The CORE320 study
T2 - An integrated analysis of CT coronary angiography and myocardial perfusion
AU - Magalhães, Tiago A.
AU - Kishi, Satoru
AU - George, Richard T.
AU - Arbab-Zadeh, Armin
AU - Vavere, Andrea L.
AU - Cox, Christopher
AU - Matheson, Matthew B.
AU - Miller, Julie M.
AU - Brinker, Jeffrey
AU - Di Carli, Marcelo
AU - Rybicki, Frank J.
AU - Rochitte, Carlos E.
AU - Clouse, Melvin E.
AU - Lima, João A.C.
N1 - Funding Information:
Conflict of interest: Tiago A. Magalhães – Nothing to disclose; Satoru Kishi – Nothing to disclose; Richard T. George – Grants from GE Healthcare, Astellas Pharma and ICON Medical Imaging; Armin Arbab-Zadeh – Institutional grants from Toshiba Medical Systems; Andrea L. Vavere – Institutional grants from Toshiba Medical Systems; Christopher Cox – Institutional grants from Toshiba Medical Systems and National Institutes of Health (NIH); Matthew B. Matheson – Nothing to disclose; Julie M. Miller – Institutional grants from Toshiba Medical Systems; Jeffrey Brinker – Grants from Johns Hopkins University; Marcelo Di Carli – Institutional grants from Toshiba Medical Systems; Frank J. Rybicki – Institutional grants from Toshiba Medical Systems; Carlos E. Rochitte – Grants from Toshiba Medical Systems; Melvin Clouse – Nothing to disclose; João A.C. Lima – Institutional grants from Toshiba Medical Systems and Bracco Diagnostic.
Publisher Copyright:
© 2015 Society of Cardiovascular Computed Tomography.
PY - 2015/9/1
Y1 - 2015/9/1
N2 - Background: The combination of coronary CT angiography (CTA) and myocardial CT perfusion (CTP) is gaining increasing acceptance, but a standardized approach to be implemented in the clinical setting is necessary. Objectives: To investigate the accuracy of a combined coronary CTA and myocardial CTP comprehensive protocol compared to coronary CTA alone, using a combination of invasive coronary angiography and single photon emission CT as reference. Methods: Three hundred eighty-one patients included in the CORE320 trial were analyzed in this study. Flow-limiting stenosis was defined as the presence of ≥50% stenosis by invasive coronary angiography with a related perfusion defect by single photon emission CT. The combined CTA + CTP definition of disease was the presence of a ≥50% stenosis with a related perfusion defect. All data sets were analyzed by 2 experienced readers, aligning anatomic findings by CTA with perfusion defects by CTP. Results: Mean patient age was 62 ± 6 years (66% male), 27% with prior history of myocardial infarction. In a per-patient analysis, sensitivity for CTA alone was 93%, specificity was 54%, positive predictive value was 55%, negative predictive value was 93%, and overall accuracy was 69%. After combining CTA and CTP, sensitivity was 78%, specificity was 73%, negative predictive value was 64%, positive predictive value was 0.85%, and overall accuracy was 75%. In a per-vessel analysis, overall accuracy of CTA alone was 73% compared to 79% for the combination of CTA and CTP (P <.0001 for difference). Conclusions: Combining coronary CTA and myocardial CTP findings through a comprehensive protocol is feasible. Although sensitivity is lower, specificity and overall accuracy are higher than assessment by coronary CTA when compared against a reference standard of stenosis with an associated perfusion defect.
AB - Background: The combination of coronary CT angiography (CTA) and myocardial CT perfusion (CTP) is gaining increasing acceptance, but a standardized approach to be implemented in the clinical setting is necessary. Objectives: To investigate the accuracy of a combined coronary CTA and myocardial CTP comprehensive protocol compared to coronary CTA alone, using a combination of invasive coronary angiography and single photon emission CT as reference. Methods: Three hundred eighty-one patients included in the CORE320 trial were analyzed in this study. Flow-limiting stenosis was defined as the presence of ≥50% stenosis by invasive coronary angiography with a related perfusion defect by single photon emission CT. The combined CTA + CTP definition of disease was the presence of a ≥50% stenosis with a related perfusion defect. All data sets were analyzed by 2 experienced readers, aligning anatomic findings by CTA with perfusion defects by CTP. Results: Mean patient age was 62 ± 6 years (66% male), 27% with prior history of myocardial infarction. In a per-patient analysis, sensitivity for CTA alone was 93%, specificity was 54%, positive predictive value was 55%, negative predictive value was 93%, and overall accuracy was 69%. After combining CTA and CTP, sensitivity was 78%, specificity was 73%, negative predictive value was 64%, positive predictive value was 0.85%, and overall accuracy was 75%. In a per-vessel analysis, overall accuracy of CTA alone was 73% compared to 79% for the combination of CTA and CTP (P <.0001 for difference). Conclusions: Combining coronary CTA and myocardial CTP findings through a comprehensive protocol is feasible. Although sensitivity is lower, specificity and overall accuracy are higher than assessment by coronary CTA when compared against a reference standard of stenosis with an associated perfusion defect.
KW - Coronary CT angiography
KW - Hybrid imaging
KW - Multislice CT
KW - Myocardial CT perfusion
KW - Myocardial perfusion imaging
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U2 - 10.1016/j.jcct.2015.03.004
DO - 10.1016/j.jcct.2015.03.004
M3 - Article
C2 - 25977111
AN - SCOPUS:84941739960
SN - 1934-5925
VL - 9
SP - 438
EP - 445
JO - Journal of cardiovascular computed tomography
JF - Journal of cardiovascular computed tomography
IS - 5
ER -