Oliver Gaemperli MD, Abstract Co-Author: Nothing to Disclose

Tiziano Schepis, Abstract Co-Author: Nothing to Disclose

Ines Valenta, Presenter: Nothing to Disclose

Pascal Koepfli, Abstract Co-Author: Nothing to Disclose

Lars Husmann MD, Abstract Co-Author: Nothing to Disclose

Hans Scheffel, Abstract Co-Author: Nothing to Disclose

Sebastian Leschka MD, Abstract Co-Author: Nothing to Disclose

Franz R. Eberli, Abstract Co-Author: Nothing to Disclose

Thomas F. Luscher, Abstract Co-Author: Nothing to Disclose

Hatem Alkadhi MD, Abstract Co-Author: Nothing to Disclose

Philipp A. Kaufmann MD, Abstract Co-Author: Nothing to Disclose

et al, Abstract Co-Author: Nothing to Disclose

et al, Abstract Co-Author: Nothing to Disclose

64-slice CTA is a promising tool for the noninvasive evaluation of coronary artery morphology. However, its value for the detection of functionally relevant coronary lesions is only poorly investigated. The aim of the present study was to determine the accuracy of 64-slice CT angiography (CTA) for the detection of functionally relevant coronary artery disease (CAD) as assessed with myocardial perfusion imaging (MPI) using SPECT.

In 78 patients (age 65±9 years) referred for elective conventional coronary angiography (CA) an additional 64-slice CTA and MPI (one-day adenosine stress/rest protocol) with 99mTc-tetrofosmin SPECT were performed prior to CA. A coronary diameter narrowing ≥50% was defined as stenosis and compared to the MPI findings. Quantitative CA served as a reference standard for CTA.

A total of 1093 coronary segments in 310 coronary arteries were analyzed. CTA revealed stenoses in 137 (13%) segments corresponding to 91 (29%) arteries in 46 (59%) patients. SPECT yielded 14 reversible, 13 fixed, and 6 partially reversible defects in 31 (40%) patients. Sensitivity, specificity, negative and positive predictive value of CTA to detect reversible MPI defects were: by patient, 95%, 53%, 97%, and 41%; by artery, 95%, 75% 100%, and 21%, respectively. Agreement between CTA and CA was good (95%, kappa=0.89, and 93%, kappa=0.83, respectively on patient- and vessel-based analysis. Pairwise comparison of ROC curves for CTA versus CA revealed comparable diagnostic accuracy for the detection of reversible perfusion defects (AUC, 0.875 [95% CI, 0.795 – 0.955] versus 0.866 [95% CI, 0.790 – 0.942]; P=NS).

64-slice CTA is a reliable tool to rule out functionally relevant CAD in a non-selected population with intermediate pretest likelihood and its diagnostic accuracy is comparable to conventional CA. An abnormal CTA, however, is a poor predictor of ischemia.

In a population with intermediate pretest likelihood 64-slice CTA allows reliable exclusion of hemodynamic significant coronary lesions with a comparable accuracy to conventional CA.

Gaemperli, O, Schepis, T, Valenta, I, Koepfli, P, Husmann, L, Scheffel, H, Leschka, S, Eberli, F, Luscher, T, Alkadhi, H, Kaufmann, P, et al, , et al, , 64-Slice CT versus Conventional Coronary Angiography: Comparable Value for Predicting Functional Relevance of Coronary Artery Disease.  Radiological Society of North America 2007 Scientific Assembly and Annual Meeting, November 25 - November 30, 2007 ,Chicago IL. http://archive.rsna.org/2007/5013993.html