Abstract 20807: Computed Tomography Perfusion Imaging with 320-row Dynamic Volume CT Accurately Detects Obstructive Atherosclerosis Causing Myocardial Perfusion Abnormalities
Background: Computed tomography coronary angiography (CTA) has been shown to be limited in the detection of myocardial ischemia. The primary aim of this study is to assess the accuracy of 320-row dynamic volume CT perfusion imaging (CTP) to detect atherosclerosis causing myocardial perfusion abnormalities.
Methods: Fifty symptomatic patients with recent single photon emission computed tomography (SPECT) imaging and an intermediate to high pre-test likelihood of coronary artery disease underwent 320-CTA followed by adenosine stress CTP imaging within 60 days of SPECT imaging. Nineteen of these patients also underwent invasive coronary angiography (ICA). CTA and ICA were analyzed for stenoses ≥ 50% severity. SPECT images were analyzed for the presence of reversible and fixed perfusion deficits. Beam hardening corrected CTP images were analyzed quantitatively for the presence of subendocardial perfusion deficits using a 17 segment model. All analyses were blinded.
Results: The prevalence of SPECT perfusion deficits was 42% and the prevalence of ≥ 50% stenoses on CTA was 36%. In the per-patient analysis, CTP was 71% sensitive and 90% specific in detecting SPECT perfusion deficits. The sensitivity and specificity of CTP in detecting a stenosis ≥ 50% severity on CTA with a corresponding SPECT perfusion deficit in the same vascular territory was 100% and 82% (per-patient) and 83% and 85% (per-vessel); respectively. In those patients who underwent ICA, the combination of a ≥ 50% stenosis on CTA with a corresponding CTP deficit to detect a ≥ 50% stenosis on ICA with a corresponding SPECT perfusion deficit in the same vascular territory was 90% and 89% (per-patient) and 75% and 91% (per-vessel); respectively. The radiation dose for CTA, CTP, and SPECT imaging was 4.5±1.8, 7.0±1.6, and 13.1±1.7 mSv; respectively.
Conclusions: In conclusion, CTP imaging with adenosine stress 320-row dynamic volume CT compares well with SPECT myocardial perfusion imaging and is accurate in detecting obstructive atherosclerosis causing myocardial ischemia.
- © 2010 by American Heart Association, Inc.