Abstract 1915: Clinical Value of 64-Slice Multidetector Computed Tomography for the Detection of Coronary Artery Stenosis: Comparison with Stress Thallium-201 Single-Photon Emission Computed Tomography
Background: Plaque and lumen area measurements by 64-slice multidetector computed tomography (MDCT) have been reported to show acceptable correlations with intravascular ultrasound. Stress myocardial perfusion imaging using single-photon emission tomography (SPECT) is an established method for noninvasive assessment of the functional significance of coronary stenosis. Here, we aimed to validate the hypothesis that quantification of coronary stenosis using 64-slice MDCT can be used to differentiate between functionally significant and non-significant coronary stenosis, compared to stress thallium-201 (Tl-201) SPECT imaging.
Methods and Results: A total of 85 patients with suspected coronary artery disease underwent 64-slice MDCT and stress Tl-201 SPECT. The plaque and lumen areas of 102 coronary lesions measured by MDCT with sufficient image quality for analysis were compared with the results of stress Tl-201 SPECT (reversible perfusion defects were positive). All the data were analyzed by two independent blinded reviewers. Among the 85 patients, 39 patients (49 lesions) had positive SPECT, while 46 patients (53 lesions) had negative SPECT. The SPECT(+) group (n = 49) showed a significantly smaller lesion lumen cross-sectional area (CSA) (2.8 ± 0.6 vs. 5.0 ± 1.4 mm2, P < 0.001) and more severe lesion area stenosis (75.6 ± 8.1 vs. 62.0 ± 9.1%, P < 0.001) that the SPECT(−) group (n = 53). A lesion lumen CSA of < 3.9 mm2 was found to be a highly accurate cut-off value for significant coronary narrowing using stress Tl-201 SPECT with a sensitivity of 94% and specificity of 87% by receiver-operating characteristics (ROC) analysis.
Conclusions: Noninvasive quantification of coronary stenosis using 64-slice MDCT can be reliably used for identifying functionally significant coronary artery disease.