Dong Hyun Yang MD, Presenter: Nothing to Disclose

Joon-Won Kang MD, Abstract Co-Author: Nothing to Disclose

Young-Hak Kim, Abstract Co-Author: Nothing to Disclose

Namkug Kim PhD, Abstract Co-Author: Stockholder, Coreline Soft, Inc

Tae-Hwan Lim MD, PhD, Abstract Co-Author: Nothing to Disclose

The aim of this study was to assess the diagnostic accuracy of stress-induced computed tomography myocardial perfusion imaging (CTP) by visual and quantitative analytic methods in patients with coronary artery disease (CAD). 

From 197 patients with suspected CAD who underwent CTP using second-generation dual-source CT, 75 who underwent coronary angiography and FFR for 210 epicardial arteries were selected for analysis. The diagnostic accuracy of visual and quantitative CTP analyses including the transmural perfusion ratio (TPR), myocardial density, and myocardial perfusion reserve index (CT density difference between stress and rest CTP images) were assessed with reference to hemodynamically significant stenosis, which was defined as FFR ≤ 0.8 or angiographically tight stenosis judged prospectively by each operator. 

From 210 epicardial arteries, hemodynamically significant stenosis was observed in 86 (41%) arteries. Per-vessel sensitivity and specificity of CTP by visual assessment were 80% and 95% in all patients, 87% and 100% in those with severe coronary calcium, and 75% and 90% in those with multivessel disease, respectively. From quantitative parameters, TPR showed the most accurate diagnostic performances with an AUC of 0.759, sensitivity of 75%, and specificity of 71%. Per-vessel sensitivity and specificity of CTP by visual assessment integrated with TPR were 93% and 84%, respectively. Mean radiation dose for CTP and CTA was 6.6 and 6.0 mSv, respectively. 

Stress myocardial CTP appears to be a feasible method for identifying inducible ischemia in patients with suspected CAD. The diagnostic accuracy of CTP may be improved if both visual and quantitative analytic results are taken into account together. 

Stress myocardial CTP appears to be an accurate method for identifying inducible ischemia in patients with suspected CAD, as compared with invasive FFR. An integrated approach using visual and quantitative analysis and careful modification of the imaging protocol will improve the diagnostic accuracy of CTP. 

Yang, D, Kang, J, Kim, Y, Kim, N, Lim, T, Validation of Stress Myocardial Perfusion Computed Tomography in Patients with Suspected Coronary Artery Disease Using Fractional Flow Reserve: Visual Assessment and Exploration of Quantitative Parameters.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14015836.html