Yuki Tanabe, Presenter: Nothing to Disclose

Teruhito Kido MD, PhD, Abstract Co-Author: Nothing to Disclose

Takahiro Yokoi, Abstract Co-Author: Nothing to Disclose

Shintaro Tsuruoka, Abstract Co-Author: Nothing to Disclose

Naoki Fukuyama, Abstract Co-Author: Nothing to Disclose

Takuya Matsuda, Abstract Co-Author: Nothing to Disclose

Rami Yokoyama, Abstract Co-Author: Nothing to Disclose

Masashi Nakamura, Abstract Co-Author: Nothing to Disclose

Yoshiko Nishiyama MD, Abstract Co-Author: Nothing to Disclose

Masao Miyagawa MD, PhD, Abstract Co-Author: Nothing to Disclose

Teruhito Mochizuki MD, Abstract Co-Author: Nothing to Disclose

The aim of this study was to evaluate the diagnostic performance of the combined CT protocol of coronary computed tomography angiography (CCTA) and pharmacological stress dynamic myocardial CT perfusion (CTP) to identify obstructive coronary artery disease (CAD).

The study group comprised 32 patients (mean age 68.1±7.8 years) who underwent ATP stress dynamic CTP using 256-slice multi detector row CT and myocardial perfusion imaging (MPI) (SPECT or cardiac MRI) prior to invasive coronary angiography (ICA). Dynamic CTP (whole heart datasets over 30 consecutive heart beats in systole) was acquired with prospective ECG gating, and subsequently CCTA scan was performed. We evaluated the diagnostic performance of the combined protocol of CCTA and quantitative CTP assessment for detecting obstructive CAD. Obstructive CAD was defined as stenosis≧50% on ICA with corresponding perfusion defect on MPI. Quantitative CTP assessment was performed with myocardial blood flow (MBF) index (mL/g/min), which was calculated by Patlak plots analysis. Results of the MBF index were compared with the results of MPI by receiver operating characteristic (ROC) analysis. The uncertain vessels on CCTA because of calcium and motion artifacts were assumed as having significant stenosis ≧50% on ICA. The combined protocol was classified positive if MBF was less than the cut-off point on CTP in areas corresponding to coronary stenosis ≧50% on CCTA. The combined protocol was negative if no stenosis ≧50% were detected on CCTA or if MBF were more than the cut-off point in areas supplied by vessels with significant stenosis or uncertain finding on CCTA.

In comparing quantitative CTP assessment with MPI, area under the ROC curve and the optimal cut-off point were 0.86 and 1.28 (mL/g/min) and sensitivity, specificity, positive predict value (PPV) and negative predict value (NPV) were 88.1%, 79.6%, 77.1% and 89.6% on a vessel level. The combined CT protocol had sensitivity of 87.8%, specificity of 83.6%, PPV of 80% and NPV of 90.2% for detecting obstructive CAD.

The combination of CCTA and quantitative CTP assessment allows comprehensive, obstructive and precise assessment of obstructive CAD with single modality.

The combined protocol of CCTA and CTP may be non-invasive useful tool for assessment coronary artery disease by one time CT examination.

Tanabe, Y, Kido, T, Yokoi, T, Tsuruoka, S, Fukuyama, N, Matsuda, T, Yokoyama, R, Nakamura, M, Nishiyama, Y, Miyagawa, M, Mochizuki, T, Diagnostic Performance of the Combined CT Protocol of Coronary CT Angiography and Dynamic Myocardial CT Perfusion Imaging to Assess Obstructive Coronary Artery Disease.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14006606.html