Diagnostic accuracy of static CT perfusion for the detection of myocardial ischemia. A systematic review and meta-analysis

Mathias Holm Sørgaard, Klaus Fuglsang Kofoed, Jesper James Linde, Richard Thomas George, Carlos Eduardo Rochitte, Gudrun Feuchtner, Joao Lima, Jawdat Abdulla

Research output: Contribution to journalArticle

Abstract

Objectives The aim of this study is to provide a meta-analysis of all published studies assessing the diagnostic accuracy of stress CT myocardial perfusion imaging (CTP) in patients suspected of or with known coronary artery disease. This analysis is limited to static stress CTP. Methods Systematic literature review and meta-analysis of studies examining the diagnostic accuracy of static CTP imaging alone or combined with coronary CT angiography (CTA) in comparison to single photon emission computed tomography (SPECT), magnetic resonance perfusion (MRP), and/or invasive coronary angiography with and without fractional flow reserve (FFR). Results The search revealed 19 eligible studies including 1188 patients. Pooled results showed that CTP had a good agreement with SPECT and MRP. On a per-patient level, sensitivity, specificity and AUC were 0.85 (95% CI: 0.70–0.93), 0.81 (95% CI: 0.59–0.93), 0.90 (95% CI: 0.87–0.92). On a per-artery level, sensitivity, specificity and AUC were 0.80 (95% CI: 0.67–0.88), 0.81 (95% CI: 0.72–0.88) and 0.87 (95% CI: 0.84–0.90). When invasive coronary angiography was used as reference standard, combined coronary CTA and CTP compared to coronary CTA alone significantly improved the specificity from 0.62 (95% CI: 0.52–0.70) to 0.84 (95% CI: 0.74–0.91) on a per-patient level (p = 0.008) and from 0.72 (95% CI: 0.63–0.79) to 0.90 (95% CI: 0.85–0.93) on a per-artery level (p = 0.0001) without significant decrease in sensitivity (p = 0.59 and p = 0.23, respectively). Conclusion In selected patients, static CT myocardial perfusion has high diagnostic accuracy to detecting myocardial ischemia. Specificity increases significantly when CT myocardial perfusion is combined with coronary CTA.

Original languageEnglish (US)
Pages (from-to)450-457
Number of pages8
JournalJournal of Cardiovascular Computed Tomography
Volume10
Issue number6
DOIs
StatePublished - Nov 1 2016

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Cytidine Triphosphate
Coronary Angiography
Myocardial Ischemia
Meta-Analysis
Perfusion
Single-Photon Emission-Computed Tomography
Area Under Curve
Magnetic Resonance Spectroscopy
Arteries
Sensitivity and Specificity
Myocardial Perfusion Imaging
Coronary Artery Disease
Computed Tomography Angiography

Keywords

  • Computed tomography perfusion
  • Coronary artery disease
  • Coronary computed tomography angiography
  • Fractional flow reserve
  • Invasive coronary angiography
  • Magnetic resonance perfusion
  • Meta-analysis
  • Single photon emission computed tomography
  • Stress myocardial perfusion

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

Cite this

Diagnostic accuracy of static CT perfusion for the detection of myocardial ischemia. A systematic review and meta-analysis. / Sørgaard, Mathias Holm; Kofoed, Klaus Fuglsang; Linde, Jesper James; George, Richard Thomas; Rochitte, Carlos Eduardo; Feuchtner, Gudrun; Lima, Joao; Abdulla, Jawdat.

In: Journal of Cardiovascular Computed Tomography, Vol. 10, No. 6, 01.11.2016, p. 450-457.

Research output: Contribution to journalArticle

Sørgaard, Mathias Holm ; Kofoed, Klaus Fuglsang ; Linde, Jesper James ; George, Richard Thomas ; Rochitte, Carlos Eduardo ; Feuchtner, Gudrun ; Lima, Joao ; Abdulla, Jawdat. / Diagnostic accuracy of static CT perfusion for the detection of myocardial ischemia. A systematic review and meta-analysis. In: Journal of Cardiovascular Computed Tomography. 2016 ; Vol. 10, No. 6. pp. 450-457.
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abstract = "Objectives The aim of this study is to provide a meta-analysis of all published studies assessing the diagnostic accuracy of stress CT myocardial perfusion imaging (CTP) in patients suspected of or with known coronary artery disease. This analysis is limited to static stress CTP. Methods Systematic literature review and meta-analysis of studies examining the diagnostic accuracy of static CTP imaging alone or combined with coronary CT angiography (CTA) in comparison to single photon emission computed tomography (SPECT), magnetic resonance perfusion (MRP), and/or invasive coronary angiography with and without fractional flow reserve (FFR). Results The search revealed 19 eligible studies including 1188 patients. Pooled results showed that CTP had a good agreement with SPECT and MRP. On a per-patient level, sensitivity, specificity and AUC were 0.85 (95{\%} CI: 0.70–0.93), 0.81 (95{\%} CI: 0.59–0.93), 0.90 (95{\%} CI: 0.87–0.92). On a per-artery level, sensitivity, specificity and AUC were 0.80 (95{\%} CI: 0.67–0.88), 0.81 (95{\%} CI: 0.72–0.88) and 0.87 (95{\%} CI: 0.84–0.90). When invasive coronary angiography was used as reference standard, combined coronary CTA and CTP compared to coronary CTA alone significantly improved the specificity from 0.62 (95{\%} CI: 0.52–0.70) to 0.84 (95{\%} CI: 0.74–0.91) on a per-patient level (p = 0.008) and from 0.72 (95{\%} CI: 0.63–0.79) to 0.90 (95{\%} CI: 0.85–0.93) on a per-artery level (p = 0.0001) without significant decrease in sensitivity (p = 0.59 and p = 0.23, respectively). Conclusion In selected patients, static CT myocardial perfusion has high diagnostic accuracy to detecting myocardial ischemia. Specificity increases significantly when CT myocardial perfusion is combined with coronary CTA.",
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T1 - Diagnostic accuracy of static CT perfusion for the detection of myocardial ischemia. A systematic review and meta-analysis

AU - Sørgaard, Mathias Holm

AU - Kofoed, Klaus Fuglsang

AU - Linde, Jesper James

AU - George, Richard Thomas

AU - Rochitte, Carlos Eduardo

AU - Feuchtner, Gudrun

AU - Lima, Joao

AU - Abdulla, Jawdat

PY - 2016/11/1

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N2 - Objectives The aim of this study is to provide a meta-analysis of all published studies assessing the diagnostic accuracy of stress CT myocardial perfusion imaging (CTP) in patients suspected of or with known coronary artery disease. This analysis is limited to static stress CTP. Methods Systematic literature review and meta-analysis of studies examining the diagnostic accuracy of static CTP imaging alone or combined with coronary CT angiography (CTA) in comparison to single photon emission computed tomography (SPECT), magnetic resonance perfusion (MRP), and/or invasive coronary angiography with and without fractional flow reserve (FFR). Results The search revealed 19 eligible studies including 1188 patients. Pooled results showed that CTP had a good agreement with SPECT and MRP. On a per-patient level, sensitivity, specificity and AUC were 0.85 (95% CI: 0.70–0.93), 0.81 (95% CI: 0.59–0.93), 0.90 (95% CI: 0.87–0.92). On a per-artery level, sensitivity, specificity and AUC were 0.80 (95% CI: 0.67–0.88), 0.81 (95% CI: 0.72–0.88) and 0.87 (95% CI: 0.84–0.90). When invasive coronary angiography was used as reference standard, combined coronary CTA and CTP compared to coronary CTA alone significantly improved the specificity from 0.62 (95% CI: 0.52–0.70) to 0.84 (95% CI: 0.74–0.91) on a per-patient level (p = 0.008) and from 0.72 (95% CI: 0.63–0.79) to 0.90 (95% CI: 0.85–0.93) on a per-artery level (p = 0.0001) without significant decrease in sensitivity (p = 0.59 and p = 0.23, respectively). Conclusion In selected patients, static CT myocardial perfusion has high diagnostic accuracy to detecting myocardial ischemia. Specificity increases significantly when CT myocardial perfusion is combined with coronary CTA.

AB - Objectives The aim of this study is to provide a meta-analysis of all published studies assessing the diagnostic accuracy of stress CT myocardial perfusion imaging (CTP) in patients suspected of or with known coronary artery disease. This analysis is limited to static stress CTP. Methods Systematic literature review and meta-analysis of studies examining the diagnostic accuracy of static CTP imaging alone or combined with coronary CT angiography (CTA) in comparison to single photon emission computed tomography (SPECT), magnetic resonance perfusion (MRP), and/or invasive coronary angiography with and without fractional flow reserve (FFR). Results The search revealed 19 eligible studies including 1188 patients. Pooled results showed that CTP had a good agreement with SPECT and MRP. On a per-patient level, sensitivity, specificity and AUC were 0.85 (95% CI: 0.70–0.93), 0.81 (95% CI: 0.59–0.93), 0.90 (95% CI: 0.87–0.92). On a per-artery level, sensitivity, specificity and AUC were 0.80 (95% CI: 0.67–0.88), 0.81 (95% CI: 0.72–0.88) and 0.87 (95% CI: 0.84–0.90). When invasive coronary angiography was used as reference standard, combined coronary CTA and CTP compared to coronary CTA alone significantly improved the specificity from 0.62 (95% CI: 0.52–0.70) to 0.84 (95% CI: 0.74–0.91) on a per-patient level (p = 0.008) and from 0.72 (95% CI: 0.63–0.79) to 0.90 (95% CI: 0.85–0.93) on a per-artery level (p = 0.0001) without significant decrease in sensitivity (p = 0.59 and p = 0.23, respectively). Conclusion In selected patients, static CT myocardial perfusion has high diagnostic accuracy to detecting myocardial ischemia. Specificity increases significantly when CT myocardial perfusion is combined with coronary CTA.

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KW - Coronary artery disease

KW - Coronary computed tomography angiography

KW - Fractional flow reserve

KW - Invasive coronary angiography

KW - Magnetic resonance perfusion

KW - Meta-analysis

KW - Single photon emission computed tomography

KW - Stress myocardial perfusion

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