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

doi:10.1007/s00330-016-4404-5

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

School of Medicine

Research output: Contribution to journal › Article › peer-review

17 Scopus citations

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 language	English (US)
Pages (from-to)	1114-1124
Number of pages	11
Journal	European radiology
Volume	27
Issue number	3
DOIs	https://doi.org/10.1007/s00330-016-4404-5
State	Published - Mar 1 2017

Keywords

Angina
Angiography
Imaging
Ischaemia
Perfusion

ASJC Scopus subject areas

Radiology Nuclear Medicine and imaging

Access to Document

10.1007/s00330-016-4404-5

Cite this

Williams, M. C., Mirsadraee, S., Dweck, M. R., Weir, N. W., Fletcher, A., Lucatelli, C., MacGillivray, T., Golay, S. K., Cruden, N. L., Henriksen, P. A., Uren, N., McKillop, G., Lima, J. A. C., Reid, J. H., van Beek, E. J. R., Patel, D., & Newby, D. E. (2017). Computed tomography myocardial perfusion vs ¹⁵O-water positron emission tomography and fractional flow reserve. European radiology, 27(3), 1114-1124. https://doi.org/10.1007/s00330-016-4404-5

Williams, MC, Mirsadraee, S, Dweck, MR, Weir, NW, Fletcher, A, Lucatelli, C, MacGillivray, T, Golay, SK, Cruden, NL, Henriksen, PA, Uren, N, McKillop, G, Lima, JAC, Reid, JH, van Beek, EJR, Patel, D & Newby, DE 2017, 'Computed tomography myocardial perfusion vs ¹⁵O-water positron emission tomography and fractional flow reserve', European radiology, vol. 27, no. 3, pp. 1114-1124. https://doi.org/10.1007/s00330-016-4404-5

@article{62e4b3f1a57b45d0bdf418dc51f87a78,

title = "Computed tomography myocardial perfusion vs 15O-water positron emission tomography and fractional flow reserve",

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.",

keywords = "Angina, Angiography, Imaging, Ischaemia, Perfusion",

author = "Williams, {Michelle C.} and Saeed Mirsadraee and Dweck, {Marc R.} and Weir, {Nicholas W.} and Alison Fletcher and Christophe Lucatelli and Tom MacGillivray and Golay, {Saroj K.} and Cruden, {Nicholas L.} and Henriksen, {Peter A.} and Neal Uren and Graham McKillop and Lima, {Jo{\~a}o A.C.} and Reid, {John H.} and {van Beek}, {Edwin J.R.} and Dilip Patel and Newby, {David E.}",

note = "Funding Information: MCW, DEN and MRD are funded by the British Heart Foundation (FS/11/014, CH/09/002). This research was funded by the British Heart Foundation and Chest Heart and Stroke Scotland (R12/A143). DEN is the recipient of a Wellcome Trust Senior Investigator Award (WT103782AIA). The Centre for Cardiovascular Science is the recipient of a British Heart Foundation Centre of Research Excellence Award (RE/08/001). The Clinical Research Imaging Centre and Wellcome Trust Clinical Research Facility (Edinburgh) are supported by National Health Service Research Scotland (NRS). Publisher Copyright: {\textcopyright} 2016, The Author(s).",

year = "2017",

month = mar,

day = "1",

doi = "10.1007/s00330-016-4404-5",

language = "English (US)",

volume = "27",

pages = "1114--1124",

journal = "European Radiology",

issn = "0938-7994",

publisher = "Springer Verlag",

number = "3",

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TY - JOUR

T1 - Computed tomography myocardial perfusion vs 15O-water positron emission tomography and fractional flow reserve

AU - Williams, Michelle C.

AU - Mirsadraee, Saeed

AU - Dweck, Marc R.

AU - Weir, Nicholas W.

AU - Fletcher, Alison

AU - Lucatelli, Christophe

AU - MacGillivray, Tom

AU - Golay, Saroj K.

AU - Cruden, Nicholas L.

AU - Henriksen, Peter A.

AU - Uren, Neal

AU - McKillop, Graham

AU - Lima, João A.C.

AU - Reid, John H.

AU - van Beek, Edwin J.R.

AU - Patel, Dilip

AU - Newby, David E.

N1 - Funding Information: MCW, DEN and MRD are funded by the British Heart Foundation (FS/11/014, CH/09/002). This research was funded by the British Heart Foundation and Chest Heart and Stroke Scotland (R12/A143). DEN is the recipient of a Wellcome Trust Senior Investigator Award (WT103782AIA). The Centre for Cardiovascular Science is the recipient of a British Heart Foundation Centre of Research Excellence Award (RE/08/001). The Clinical Research Imaging Centre and Wellcome Trust Clinical Research Facility (Edinburgh) are supported by National Health Service Research Scotland (NRS). Publisher Copyright: © 2016, The Author(s).

PY - 2017/3/1

Y1 - 2017/3/1

N2 - 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.

AB - 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.

KW - Angina

KW - Angiography

KW - Imaging

KW - Ischaemia

KW - Perfusion

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