Diagnostic performance of fusion of myocardial perfusion imaging (MPI) and computed tomography coronary angiography

• Published in: Journal of nuclear cardiology Vol. 16; no. 2; pp. 201 - 211
• Main Authors: Santana, Cesar A., Garcia, Ernest V., Faber, Tracy L., Sirineni, Gopi K. R., Esteves, Fabio P., Sanyal, Rupan, Halkar, Raghuveer, Ornelas, Mario, Verdes, Liudmila, Lerakis, Stamatios, Ramos, Julie J., Aguadé-Bruix, Santiago, Cuéllar, Hugo, Candell-Riera, Jaume, Raggi, Paolo
• Format: Journal Article
• Language: English
• Published: New York Springer-Verlag 01.04.2009; Springer Nature B.V
• Subjects: Cardiology; Coronary Angiography - methods; Coronary Artery Disease - complications; Coronary Artery Disease - diagnosis; Female; Humans; Imaging; Male; Medicine; Medicine & Public Health; Middle Aged; Nuclear Medicine; Original Article; Radiology; Reproducibility of Results; Sensitivity and Specificity; Subtraction Technique; Tomography, Emission-Computed, Single-Photon - methods; Tomography, X-Ray Computed - methods; Ventricular Dysfunction, Left - diagnosis; Ventricular Dysfunction, Left - etiology; coronary artery disease; Myocardial perfusion imaging; PET imaging; computed tomography (CT); SPECT; diagnostic and prognostic application
• ISSN: 1071-3581; 1532-6551
• DOI: 10.1007/s12350-008-9019-z

Background We evaluated the incremental diagnostic value of fusion images of coronary computed tomography angiography (CTA) and myocardial perfusion imaging (MPI) over MPI alone or MPI and CTA side-by-side to identify obstructive coronary artery disease (CAD > 50% stenosis) using invasive coronary angiography (ICA) as the gold standard. Methods 50 subjects (36 men; 56 ± 11 years old) underwent rest-stress MPI and CTA within 12-26 days of each other. CTAs were performed with multi-detector CT-scanners (31 on 64-slice; and 19 on 16-slice). 37 patients underwent ICA while 13 subjects did not because of low (<5%) pre-test likelihood (LLK) of disease. Three blinded readers scored the images in sequential sessions using (1) MPI alone (2) MPI and CTA side-by-side, (3) fused CTA/MPI images. Results One or more critical stenoses during ICA were found in 28 patients and non-critical stenoses were found in 9 patients. MPI, side-by-side MPI-CTA, and fused CTA/MPI showed the same normalcy rate (NR:13/13) in LLK subjects. The fusion technique performed better than MPI and MPI and CTA side-by-side for the presence of CAD in any vessel (overall area under the curve (AUC) for fused images: 0.89; P  = .005 vs MPI, P  = .04 vs side-by-side MPI-CTA) and for localization of CAD to the left anterior descending coronary artery (AUC: 0.82, P  < .001 vs MPI; P  = .007 vs side-by-side MPI-CTA). There was a non-significant trend for better detection of multi-vessel disease with fusion. Conclusions Using ICA as the gold standard, fusion imaging provided incremental diagnostic information compared to MPI alone or side-by-side MPI-CTA for the diagnosis of obstructive CAD and for localization of CAD to the left anterior descending coronary artery.