A randomized, multicenter, multivendor study of myocardial perfusion imaging with regadenoson CT perfusion vs single photon emission CT

Ricardo C. Cury, Therese M. Kitt, Kathleen Feaheny, Ron Blankstein, Brian B. Ghoshhajra, Matthew J. Budoff, Jonathon Leipsic, James K. Min, Jamie Akin, Richard T. George

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Myocardial CT perfusion (CTP) is a promising tool for the detection of myocardial ischemia. We hypothesize that regadenoson CTP is noninferior to regadenoson single photon emission CT (SPECT) for detecting or excluding myocardial ischemia. Methods: Patients (men ≥45years; women ≥50years) with known or suspected coronary artery disease (n= 124) were randomized to 1 of 2 diagnostic sequences: rest and regadenoson SPECT on day 1, then regadenoson CTP and rest CTP (and coronary CT angiography [CTA]) (CTA; same acquisition) on day 2 or regadenoson CTP and rest CTP (and CTA) on Day 1, then rest and regadenoson SPECT on day 2. Scanning platforms included 64-, 128-, 256-, and 320-slice systems. The primary analysis examined the agreement rate between CTP and SPECT for detecting or excluding reversible ischemia in ≥2 myocardial segments as assessed by independent, blinded readers. Results: Complete and interpretable CTP and SPECT scans were obtained for 110 patients. Regadenoson CTP was noninferior to SPECT for detecting or excluding reversible ischemia with an agreement rate of 0.87 (95% confidence interval [CI], 0.77-0.97) and sensitivity and specificity of 0.90 (95% CI, 0.71-1.00) and 0.84 (95% CI, 0.77-0.91), respectively. The agreement rate for detecting or excluding ≥1 fixed defects by regadenoson CTP and SPECT was 0.86 (95% CI, 0.74-0.98). With SPECT as the reference standard, the diagnostic accuracies for detecting or excluding ischemia by regadenoson CTP and CTA alone were 0.85 (95% CI, 0.78-0.91) and 0.69 (95% CI, 0.60-0.77), respectively. Conclusions: This study establishes the noninferiority of regadenoson CTP to SPECT for detecting or excluding myocardial ischemia.

Original languageEnglish (US)
Pages (from-to)103-112
Number of pages10
JournalJournal of Cardiovascular Computed Tomography
Volume9
Issue number2
DOIs
StatePublished - 2015

Keywords

  • CT perfusion
  • Myocardial ischemia
  • Regadenoson
  • Single photon emission CT

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Radiology Nuclear Medicine and imaging
  • Medicine(all)

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