TY - JOUR
T1 - Coronary artery disease
T2 - Analysis of diagnostic performance of ct perfusion and MR perfusion imaging in comparison with quantitative coronary angiography and SPECT-multicenter prospective trial
AU - Rief, Matthias
AU - Chen, Marcus Y.
AU - Vavere, Andrea L.
AU - Kendziora, Benjamin
AU - Miller, Julie M.
AU - Bandettini, W. Patricia
AU - Cox, Christopher
AU - George, Richard
AU - Lima, João
AU - Di Carli, Marcelo
AU - Plotkin, Michail
AU - Zimmermann, Elke
AU - Laule, Michael
AU - Schlattmann, Peter
AU - Arai, Andrew E.
AU - Dewey, Marc
N1 - Funding Information:
the study design, data acquisition, data analysis, or manuscript preparation, nor was it involved in the decision to submit this substudy for publication. No financial support was provided for this substudy, and all costs related to it were the responsibility of the two respective centers (NIH and Chari-té–Universitätsmedizin Berlin). The CORE320 protocol has been published by Vavere et al (17). In agreement with the CORE320 protocol, this substudy used the two reference standards that were prospectively defined by the study steering committee: QCA and SPECT were used in combination to reflect anatomic and functional disease, while QCA alone was used to reflect anatomic disease (17). Additional analysis with SPECT alone as a reference standard was available on request during the review process. At QCA, detection of coronary artery stenosis of at least 50% was considered to represent CAD for the purpose of this analysis. For combined QCA and SPECT, alignment between coronary artery stenosis and myocardial perfusion territories was performed as defined in the CORE320 protocol by Cerci et al (18). This myocardial territory segmentation model consists of six segments distributed in the basal myocardium (segments 1–6), another six segments in the apical myocardium (segments 7–12), and one segment in the apex (segment 13). The numbers are given in ascending order for the anterior, anteroseptal, inferoseptal, inferior, inferolateral, and anterolateral segments. The apex (segment 13) was excluded in our analysis, as it is not part of a standard MR perfusion protocol. Vascular territory maps were defined for the following vessels: left main, proximal left anterior descending artery, middistal anterior left descending artery, left circumflex artery, right coronary artery, and Ramus branch of the left circumflex artery. Primary territories were aligned to the respective coronary artery under the assumption of the most common right dominant anatomic coronary pattern. Secondary territories were assumed to have a possible blood supply from the respective coronary artery in normal anatomic variations, and tertiary territories were assumed not to be supplied by the coronary artery (18). The myocardial segments and the vascular territories were also used for MR image reading to achieve consistency with the reading technique used for CT perfusion and SPECT images. All criteria of the Standards for Reporting of Diagnostic Accuracy statement can be found in this report. The study protocol and this substudy on the comparison of myocardial CT perfusion with MR perfusion imaging were approved by the institutional review boards of the two institutions and the German Federal Office for Radiation Protection. Each patient gave written informed consent. The primary analysis included patients who underwent each imaging procedure, including SPECT, MR perfusion imaging, CT perfusion, and ICA.
Funding Information:
Supported by Deutsche Forschungsgemeinschaft (Heisenberg Program DE 1361/14-1) and Toshiba Medical Systems (now Canon) (CORE320 trial, NCT00934037).
PY - 2018/2
Y1 - 2018/2
N2 - Purpose: To compare the diagnostic performance of stress myocardial computed tomography (CT) perfusion with that of stress myocardial magnetic resonance (MR) perfusion imaging in the detection of coronary artery disease (CAD). Materials and Methods: All patients gave written informed consent prior to inclusion in this institutional review board-approved study. This two-center substudy of the prospective Combined Noninvasive Coronary Angiography and Myocardial Perfusion Imaging Using 320-Detector Row Computed Tomography (CORE320) multicenter trial included 92 patients (mean age, 63.1 years 6 8.1 [standard deviation]; 73% male). All patients underwent perfusion CT and perfusion MR imaging with either adenosine or regadenoson stress. The predefined reference standards were combined quantitative coronary angiography (QCA) and single-photon emission CT (SPECT) or QCA alone. Results from coronary CT angiography were not included, and diagnostic performance was evaluated with the Mantel- Haenszel test stratified by disease status. Results: The prevalence of CAD was 39% (36 of 92) according to QCA and SPECT and 64% (59 of 92) according to QCA alone. When compared with QCA and SPECT, per-patient diagnostic accuracy of perfusion CT and perfusion MR imaging was 63% (58 of 92) and 75% (69 of 92), respectively (P = .11); sensitivity was 92% (33 of 36) and 83% (30 of 36), respectively (P = .45); and specificity was 45% (25 of 56) and 70% (39 of 56), respectively (P , .01). When compared with QCA alone, diagnostic accuracy of CT perfusion and MR perfusion imaging was 82% (75 of 92) and 74% (68 of 92), respectively (P = .27); sensitivity was 90% (53 of 59) and 69% (41 of 59), respectively (P , .01); and specificity was 67% (22 of 33) and 82% (27 of 33), respectively (P = .27). Conclusion: This multicenter study shows that the diagnostic performance of perfusion CT is similar to that of perfusion MR imaging in the detection of CAD.
AB - Purpose: To compare the diagnostic performance of stress myocardial computed tomography (CT) perfusion with that of stress myocardial magnetic resonance (MR) perfusion imaging in the detection of coronary artery disease (CAD). Materials and Methods: All patients gave written informed consent prior to inclusion in this institutional review board-approved study. This two-center substudy of the prospective Combined Noninvasive Coronary Angiography and Myocardial Perfusion Imaging Using 320-Detector Row Computed Tomography (CORE320) multicenter trial included 92 patients (mean age, 63.1 years 6 8.1 [standard deviation]; 73% male). All patients underwent perfusion CT and perfusion MR imaging with either adenosine or regadenoson stress. The predefined reference standards were combined quantitative coronary angiography (QCA) and single-photon emission CT (SPECT) or QCA alone. Results from coronary CT angiography were not included, and diagnostic performance was evaluated with the Mantel- Haenszel test stratified by disease status. Results: The prevalence of CAD was 39% (36 of 92) according to QCA and SPECT and 64% (59 of 92) according to QCA alone. When compared with QCA and SPECT, per-patient diagnostic accuracy of perfusion CT and perfusion MR imaging was 63% (58 of 92) and 75% (69 of 92), respectively (P = .11); sensitivity was 92% (33 of 36) and 83% (30 of 36), respectively (P = .45); and specificity was 45% (25 of 56) and 70% (39 of 56), respectively (P , .01). When compared with QCA alone, diagnostic accuracy of CT perfusion and MR perfusion imaging was 82% (75 of 92) and 74% (68 of 92), respectively (P = .27); sensitivity was 90% (53 of 59) and 69% (41 of 59), respectively (P , .01); and specificity was 67% (22 of 33) and 82% (27 of 33), respectively (P = .27). Conclusion: This multicenter study shows that the diagnostic performance of perfusion CT is similar to that of perfusion MR imaging in the detection of CAD.
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U2 - 10.1148/radiol.2017162447
DO - 10.1148/radiol.2017162447
M3 - Article
C2 - 28956734
AN - SCOPUS:85041455956
SN - 0033-8419
VL - 286
SP - 461
EP - 470
JO - RADIOLOGY
JF - RADIOLOGY
IS - 2
ER -