Sung Min Ko, Presenter: Nothing to Disclose

Hweung Kgon Hwang, Abstract Co-Author: Nothing to Disclose

To determine the diagnostic performance of stress dual energy computed tomography myocardial perfusion imaging (DECT-MPI) for identification and exclusion of coronary artery stenoses that cause ischemia.

We performed a prospective study of consecutive patients who underwent coronary CT angiography (CCTA), DECT-MPI, invasive coronary angiography (ICA) and cardiac magnetic resonance (CMR)-MPI. DECT-MPI and CMR-MPI were evaluated for the presence or absence of myocardial perfusion defects. CCTA and ICA were evaluated for the presence or absence of anatomically obstructive stenosis, as defined by a >50% stenosis. The primary endpoint was lesion-specific ischemia on a per-patient basis, as defined by a combination of a >50% stenosis by ICA and an associated perfusion defect by CMR-MPI. In exploratory analyses, DECT-MPI and CCTA were compared directly to CMR-MPI and ICA, respectively.

One hundred ninety-two patients (135 men, 63.1 ± 8.0 years) comprised the study cohort. 144 (75%) patients and 257 (45%) vascular territories exhibited ischemia-causing coronary stenoses. On a vessel-based model, the sensitivity, specificity, and positive and negative predictive values to detect ischemia-causing coronary lesions was 88%, 82%, 79% and 89%, respectively for DECT-MPI and CCTA; 91%, 75%, 75% and 92%, respectively for DECT-MPI alone; and 95%, 45% 63% and 94%, respectively for CCTA alone. Area under the receiver operating characteristics curve for DECT-MPI and CCTA was higher than for CCTA alone (0.85 vs. 0.75, p = 0.001).

Combined DECT-MPI and CCTA improves the identification and discrimination of ischemia-causing coronary stenosis over CCTA alone, but compared to a combined ICA/CMR-MPI, combined CCTA/stress DECT-MPI improves the predictive value for coronary stenoses causing ischemia compared to that of CCTA but only mildly improves the diagnostic performance of stress DECT-MPI alone.

Dual energy CT (DECT) is a novel method that allows for mapping of myocardial contrast for evaluation of myocardial perfusion. Stress DECT-MPI provides clinical benefit to patients with insufficiently evaluated coronary lesions by CCTA alone.

Ko, S, Hwang, H, Dual Energy CT Myocardial Perfusion Imaging and Coronary CT Angiography for Identification of Ischemia-causing Coronary Lesions.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14018757.html