Computed tomography myocardial perfusion vs 15O-water positron emission tomography and fractional flow reserve

Michelle C. Williams, Saeed Mirsadraee, Marc R. Dweck, Nicholas W. Weir, Alison Fletcher, Christophe Lucatelli, Tom MacGillivray, Saroj K. Golay, Nicholas L. Cruden, Peter A. Henriksen, Neal Uren, Graham McKillop, João A.C. Lima, John H. Reid, Edwin J.R. van Beek, Dilip Patel, David E. Newby

Research output: Contribution to journalArticlepeer-review

Abstract

Objectives: Computed tomography (CT) can perform comprehensive cardiac imaging. We compared CT coronary angiography (CTCA) and CT myocardial perfusion (CTP) with 15O-water positron emission tomography (PET) and invasive coronary angiography (ICA) with fractional flow reserve (FFR). Methods: 51 patients (63 (61–65) years, 80 % male) with known/suspected coronary artery disease (CAD) underwent 320-multidetector CTCA followed by “snapshot” adenosine stress CTP. Of these 22 underwent PET and 47 ICA/FFR. Obstructive CAD was defined as CTCA stenosis >50 % and CTP hypoperfusion, ICA stenosis >70 % or FFR <0.80. Results: PET hyperaemic myocardial blood flow (MBF) was lower in obstructive than non-obstructive territories defined by ICA/FFR (1.76 (1.32–2.20) vs 3.11 (2.44–3.79) mL/(g/min), P < 0.001) and CTCA/CTP (1.76 (1.32–2.20) vs 3.12 (2.44–3.79) mL/(g/min), P < 0.001). Baseline and hyperaemic CT attenuation density was lower in obstructive than non-obstructive territories (73 (71–76) vs 86 (84–88) HU, P < 0.001 and 101 (96–106) vs 111 (107–114) HU, P 0.001). PET hyperaemic MBF corrected for rate pressure product correlated with CT attenuation density (r = 0.579, P < 0.001). There was excellent per-patient sensitivity (96 %), specificity (85 %), negative predictive value (90 %) and positive predictive value (94 %) for CTCA/CTP vs ICA/FFR. Conclusion: CT myocardial attenuation density correlates with 15O-water PET MBF. CTCA and CTP can accurately identify obstructive CAD. Key Points: •CT myocardial perfusion can aid the assessment of suspected coronary artery disease. • CT attenuation density from “snapshot” imaging is a marker of myocardial perfusion. • CT myocardial attenuation density correlates with15O-water PET myocardial blood flow. • CT attenuation density is lower in obstructive territories defined by invasive angiography. • Diagnostic accuracy of CTCA+CTP is comparable to invasive angiography + fractional flow reserve.

Original languageEnglish (US)
Pages (from-to)1114-1124
Number of pages11
JournalEuropean radiology
Volume27
Issue number3
DOIs
StatePublished - Mar 1 2017

Keywords

  • Angina
  • Angiography
  • Imaging
  • Ischaemia
  • Perfusion

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

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