Static CT myocardial perfusion imaging: image quality, artifacts including distribution and diagnostic performance compared to <sup>82</sup>Rb PET

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Abstract

Background

Rubidium-82 positron emission tomography ( ⁸²Rb PET) MPI is considered a noninvasive reference standard for the assessment of myocardial perfusion in coronary artery disease (CAD) patients. Our main goal was to compare the diagnostic performance of static rest/ vasodilator stress CT myocardial perfusion imaging (CT-MPI) to stress/ rest ⁸²Rb PET-MPI for the identification of myocardial ischemia.

Methods

Forty-four patients with suspected or diagnosed CAD underwent both static CT-MPI and ⁸²Rb PET-MPI at rest and during pharmacological stress. The extent and severity of perfusion defects on PET-MPI were assessed to obtain summed stress score, summed rest score, and summed difference score. The extent and severity of perfusion defects on CT-MPI was visually assessed using the same grading scale. CT-MPI was compared with PET-MPI as the gold standard on a per-territory and a per-patient basis.

Results

On a per-patient basis, there was moderate agreement between CT-MPI and PET-MPI with a weighted 0.49 for detection of stress induced perfusion abnormalities. Using PET-MPI as a reference, static CT-MPI had 89% sensitivity (SS), 58% specificity (SP), 71% accuracy (AC), 88% negative predictive value (NPV), and 59% positive predictive value (PPV) to diagnose stress-rest perfusion deficits on a per-patient basis. On a per-territory analysis, CT-MPI had 73% SS, 65% SP, 67% AC, 90.8% NPV, and 34% PPV to diagnose perfusion deficits.

Conclusions

CT-MPI has high sensitivity and good overall accuracy for the diagnosis of functionally significant CAD using ⁸²Rb PET-MPI as the reference standard. CT-MPI may play an important role in assessing the functional significance of CAD especially in combination with CCTA.

Related collections

Most cited references 47

Record: found
Abstract: not found
Article: not found

Standardized myocardial segmentation and nomenclature for tomographic imaging of the heart. A statement for healthcare professionals from the Cardiac Imaging Committee of the Council on Clinical Cardiology of the American Heart Association.

Manuel Cerqueira, Neil Weissman, Vasken Dilsizian … (2002)

0 comments Cited 392 times – based on 0 reviews      Review now

Bookmark

Record: found
Abstract: found
Article: not found

Measurement of fractional flow reserve to assess the functional severity of coronary-artery stenoses.

N. H. Pijls, B. De Bruyne, K Peels … (1996)

The clinical significance of coronary-artery stenoses of moderate severity can be difficult to determine. Myocardial fractional flow reserve (FFR) is a new index of the functional severity of coronary stenoses that is calculated from pressure measurements made during coronary arteriography. We compared this index with the results of noninvasive tests commonly used to detect myocardial ischemia, to determine the usefulness of the index. In 45 consecutive patients with moderate coronary stenosis and chest pain of uncertain origin, we performed bicycle exercise testing, thallium scintigraphy, stress echocardiography with dobutamine, and quantitative coronary arteriography and compared the results with measurements of FFR. In all 21 patients with an FFR of less than 0.75, reversible myocardial ischemia was demonstrated unequivocally on at least one noninvasive test. After coronary angioplasty or bypass surgery was performed, all the positive test results reverted to normal. In contrast, 21 of the 24 patients with an FFR of 0.75 or higher tested negative for reversible myocardial ischemia on all the noninvasive tests. No revascularization procedures were performed in these patients, and none were required during 14 months of follow-up. The sensitivity of FFR in the identification of reversible ischemia was 88 percent, the specificity 100 percent, the positive predictive value 100 percent, the negative predictive value 88 percent, and the accuracy 93 percent. In patients with coronary stenosis of moderate severity, FFR appears to be a useful index of the functional severity of the stenoses and the need for coronary revascularization.

0 comments Cited 387 times – based on 0 reviews      Review now

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Record: found
Abstract: found
Article: not found

Fractional Flow Reserve–Guided PCI versus Medical Therapy in Stable Coronary Disease

Bernard De Bruyne, Nico H.J. Pijls, Bindu Kalesan … (2012)

The preferred initial treatment for patients with stable coronary artery disease is the best available medical therapy. We hypothesized that in patients with functionally significant stenoses, as determined by measurement of fractional flow reserve (FFR), percutaneous coronary intervention (PCI) plus the best available medical therapy would be superior to the best available medical therapy alone. In patients with stable coronary artery disease for whom PCI was being considered, we assessed all stenoses by measuring FFR. Patients in whom at least one stenosis was functionally significant (FFR, ≤0.80) were randomly assigned to FFR-guided PCI plus the best available medical therapy (PCI group) or the best available medical therapy alone (medical-therapy group). Patients in whom all stenoses had an FFR of more than 0.80 were entered into a registry and received the best available medical therapy. The primary end point was a composite of death, myocardial infarction, or urgent revascularization. Recruitment was halted prematurely after enrollment of 1220 patients (888 who underwent randomization and 332 enrolled in the registry) because of a significant between-group difference in the percentage of patients who had a primary end-point event: 4.3% in the PCI group and 12.7% in the medical-therapy group (hazard ratio with PCI, 0.32; 95% confidence interval [CI], 0.19 to 0.53; P<0.001). The difference was driven by a lower rate of urgent revascularization in the PCI group than in the medical-therapy group (1.6% vs. 11.1%; hazard ratio, 0.13; 95% CI, 0.06 to 0.30; P<0.001); in particular, in the PCI group, fewer urgent revascularizations were triggered by a myocardial infarction or evidence of ischemia on electrocardiography (hazard ratio, 0.13; 95% CI, 0.04 to 0.43; P<0.001). Among patients in the registry, 3.0% had a primary end-point event. In patients with stable coronary artery disease and functionally significant stenoses, FFR-guided PCI plus the best available medical therapy, as compared with the best available medical therapy alone, decreased the need for urgent revascularization. In patients without ischemia, the outcome appeared to be favorable with the best available medical therapy alone. (Funded by St. Jude Medical; ClinicalTrials.gov number, NCT01132495.).

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Author and article information

Contributors

Girish Dwivedi:

ORCID: http://orcid.org/0000-0003-0717-740X

girish.dwivedi@perkins.uwa.edu.au

Journal

Journal ID (nlm-ta): Eur J Hybrid Imaging

Journal ID (iso-abbrev): Eur J Hybrid Imaging

Title: European Journal of Hybrid Imaging

Publisher: Springer International Publishing (Cham )

ISSN (Electronic): 2510-3636

Publication date (Electronic): 4 January 2022

Publication date PMC-release: 4 January 2022

Publication date Collection: December 2022

Volume: 6

Electronic Location Identifier: 1

Affiliations

[1 ]GRID grid.28046.38, ISNI 0000 0001 2182 2255, Department of Radiology, The Ottawa Hospital, University of Ottawa Research Institute, , University of Ottawa, ; Ottawa, Canada

[2 ]Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal

[3 ]GRID grid.1012.2, ISNI 0000 0004 1936 7910, Medical School, Harry Perkins Institute of Medical Research, , The University of Western Australia, ; Perth, Australia

[4 ]GRID grid.28046.38, ISNI 0000 0001 2182 2255, Division of Cardiology, Department of Medicine, , University of Ottawa Heart Institute, ; Ottawa, Canada

[5 ]GRID grid.24827.3b, ISNI 0000 0001 2179 9593, Department of Radiology, , University of Cincinnati, ; Cincinnati, OH USA

[6 ]Imagia, Montreal, QC Canada

[7 ]GRID grid.431595.f, ISNI 0000 0004 0469 0045, Department of Advanced Clinical and Translational Cardiovascular Imaging, , Harry Perkins Institute of Medical Research and Fiona Stanley Hospital, ; Murdoch, Australia

Author information

Girish Dwivedi http://orcid.org/0000-0003-0717-740X

Article

Publisher ID: 118

DOI: 10.1186/s41824-021-00118-x

PMC ID: 8724508

PubMed ID: 34981241

SO-VID: 74e3a967-7315-41a4-a7f9-7546f22da9be

License:

Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

History

Date received : 11 September 2021

Date accepted : 3 November 2021

Custom metadata

Keywords: computed tomography,ischemia,myocardial perfusion imaging,rubidium positron emission tomography

Data availability:

Keywords: computed tomography, ischemia, myocardial perfusion imaging, rubidium positron emission tomography

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