Combined coronary angiography and myocardial perfusion by computed tomography in the identification of flow-limiting stenosis - The CORE320 study: An integrated analysis of CT coronary angiography and myocardial perfusion

Tiago A. Magalhães, Satoru Kishi, Richard T. George, Armin Arbab-Zadeh, Andrea L. Vavere, Christopher Cox, Matthew B. Matheson, Julie M. Miller, Jeffrey Brinker, Marcelo Di Carli, Frank J. Rybicki, Carlos E. Rochitte, Melvin E. Clouse, João A.C. Lima

Research output: Contribution to journalArticlepeer-review

Abstract

Background: The combination of coronary CT angiography (CTA) and myocardial CT perfusion (CTP) is gaining increasing acceptance, but a standardized approach to be implemented in the clinical setting is necessary. Objectives: To investigate the accuracy of a combined coronary CTA and myocardial CTP comprehensive protocol compared to coronary CTA alone, using a combination of invasive coronary angiography and single photon emission CT as reference. Methods: Three hundred eighty-one patients included in the CORE320 trial were analyzed in this study. Flow-limiting stenosis was defined as the presence of ≥50% stenosis by invasive coronary angiography with a related perfusion defect by single photon emission CT. The combined CTA + CTP definition of disease was the presence of a ≥50% stenosis with a related perfusion defect. All data sets were analyzed by 2 experienced readers, aligning anatomic findings by CTA with perfusion defects by CTP. Results: Mean patient age was 62 ± 6 years (66% male), 27% with prior history of myocardial infarction. In a per-patient analysis, sensitivity for CTA alone was 93%, specificity was 54%, positive predictive value was 55%, negative predictive value was 93%, and overall accuracy was 69%. After combining CTA and CTP, sensitivity was 78%, specificity was 73%, negative predictive value was 64%, positive predictive value was 0.85%, and overall accuracy was 75%. In a per-vessel analysis, overall accuracy of CTA alone was 73% compared to 79% for the combination of CTA and CTP (P <.0001 for difference). Conclusions: Combining coronary CTA and myocardial CTP findings through a comprehensive protocol is feasible. Although sensitivity is lower, specificity and overall accuracy are higher than assessment by coronary CTA when compared against a reference standard of stenosis with an associated perfusion defect.

Original languageEnglish (US)
Pages (from-to)438-445
Number of pages8
JournalJournal of cardiovascular computed tomography
Volume9
Issue number5
DOIs
StatePublished - Sep 1 2015

Keywords

  • Coronary CT angiography
  • Hybrid imaging
  • Multislice CT
  • Myocardial CT perfusion
  • Myocardial perfusion imaging

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

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