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Accuracy of 64-slice CT angiography for the detection of functionally relevant coronary stenoses as assessed with myocardial perfusion SPECT

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Abstract

Purpose

CT angiography (CTA) offers a valuable alternative for the diagnosis of CAD but its value in the detection of functionally relevant coronary stenoses remains uncertain. We prospectively compared the accuracy of 64-slice CTA with that of myocardial perfusion imaging (MPI) using 99mTc-tetrofosmin-SPECT as the gold standard for the detection of functionally relevant coronary artery disease (CAD).

Methods

MPI and 64-slice CT were performed in 100 consecutive patients. CTA lesions were analysed quantitatively and area stenoses ≥50% and ≥75% were compared with the MPI findings.

Results

In 23 patients, MPI perfusion defects were found (12 reversible, 13 fixed). A total of 399 coronary arteries and 1,386 segments was analysed. Eighty-four segments (6.1%) in 23 coronary arteries (5.8%) of nine patients (9.0%) were excluded owing to insufficient image quality. In the remaining 1,302 segments, quantitative CTA revealed stenoses ≥50% in 57 of 376 coronary arteries (15.2%) and stenoses ≥75% in 32 (8.5%) coronary arteries. Using a cut-off at ≥75% area stenosis, CTA yielded the following sensitivity, specificity, negative (NPV) and positive predictive value (PPV), and accuracy for the detection of any (fixed and reversible) MPI defect: by patient, 75%, 90%, 93%, 68% and 87%, respectively; by artery, 76%, 95%, 99%, 50% and 94%, respectively.

Conclusion

Sixty-four-slice CTA is a reliable tool to rule out functionally relevant CAD in a non-selected population with an intermediate pretest likelihood of disease. However, an abnormal CTA is a poor predictor of ischaemia.

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Acknowledgements

This study was supported by a grant from the Swiss National Science Foundation (SNSF-professorship grant No. PP00A-68835) and by a grant from the National Center of Competence in Research, Computer Aided and Image Guided Medical Interventions (NCCR CO-ME) of the Swiss National Science Foundation.

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Authors and Affiliations

  1. Nuclear Cardiology, Cardiovascular Center, University Hospital Zurich NUK C 40, Raemistrasse 100, 8091, Zurich, Switzerland

    Oliver Gaemperli, Tiziano Schepis, Pascal Koepfli, Ines Valenta, Jan Soyka & Philipp A. Kaufmann

  2. Institute of Diagnostic Radiology, University Hospital Zurich, Zurich, Switzerland

    Sebastian Leschka, Lotus Desbiolles, Lars Husmann & Hatem Alkadhi

  3. Zurich Center for Integrative Human Physiology (CIHP), University of Zurich, Zurich, Switzerland

    Philipp A. Kaufmann

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  1. Oliver Gaemperli
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Correspondence to Philipp A. Kaufmann.

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Gaemperli, O., Schepis, T., Koepfli, P. et al. Accuracy of 64-slice CT angiography for the detection of functionally relevant coronary stenoses as assessed with myocardial perfusion SPECT. Eur J Nucl Med Mol Imaging 34, 1162–1171 (2007). https://doi.org/10.1007/s00259-006-0307-z

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  • DOI: https://doi.org/10.1007/s00259-006-0307-z

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