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Open Access 01-03-2017 | Cardiac

Computed tomography myocardial perfusion vs ¹⁵O-water positron emission tomography and fractional flow reserve

Authors: Michelle C. Williams, Saeed Mirsadraee, Marc R. Dweck, Nicholas W. Weir, Alison Fletcher, Christophe Lucatelli, Tom MacGillivray, Saroj K. Golay, Nicholas L. Cruden, Peter A. Henriksen, Neal Uren, Graham McKillop, João A. C. Lima, John H. Reid, Edwin J. R. van Beek, Dilip Patel, David E. Newby

Published in: European Radiology | Issue 3/2017

Abstract

Objectives

Computed tomography (CT) can perform comprehensive cardiac imaging. We compared CT coronary angiography (CTCA) and CT myocardial perfusion (CTP) with ¹⁵O-water positron emission tomography (PET) and invasive coronary angiography (ICA) with fractional flow reserve (FFR).

Methods

51 patients (63 (61–65) years, 80 % male) with known/suspected coronary artery disease (CAD) underwent 320-multidetector CTCA followed by “snapshot” adenosine stress CTP. Of these 22 underwent PET and 47 ICA/FFR. Obstructive CAD was defined as CTCA stenosis >50 % and CTP hypoperfusion, ICA stenosis >70 % or FFR <0.80.

Results

PET hyperaemic myocardial blood flow (MBF) was lower in obstructive than non-obstructive territories defined by ICA/FFR (1.76 (1.32–2.20) vs 3.11 (2.44–3.79) mL/(g/min), P < 0.001) and CTCA/CTP (1.76 (1.32–2.20) vs 3.12 (2.44–3.79) mL/(g/min), P < 0.001). Baseline and hyperaemic CT attenuation density was lower in obstructive than non-obstructive territories (73 (71–76) vs 86 (84–88) HU, P < 0.001 and 101 (96–106) vs 111 (107–114) HU, P 0.001). PET hyperaemic MBF corrected for rate pressure product correlated with CT attenuation density (r = 0.579, P < 0.001). There was excellent per-patient sensitivity (96 %), specificity (85 %), negative predictive value (90 %) and positive predictive value (94 %) for CTCA/CTP vs ICA/FFR.

Conclusion

CT myocardial attenuation density correlates with ¹⁵O-water PET MBF. CTCA and CTP can accurately identify obstructive CAD.

Key Points

•CT myocardial perfusion can aid the assessment of suspected coronary artery disease.

• CT attenuation density from “snapshot” imaging is a marker of myocardial perfusion.

• CT myocardial attenuation density correlates with ¹⁵ O-water PET myocardial blood flow.

• CT attenuation density is lower in obstructive territories defined by invasive angiography.

• Diagnostic accuracy of CTCA+CTP is comparable to invasive angiography + fractional flow reserve.

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Title: Computed tomography myocardial perfusion vs 15O-water positron emission tomography and fractional flow reserve
Authors: Michelle C. Williams
Saeed Mirsadraee
Marc R. Dweck
Nicholas W. Weir
Alison Fletcher
Christophe Lucatelli
Tom MacGillivray
Saroj K. Golay
Nicholas L. Cruden
Peter A. Henriksen
Neal Uren
Graham McKillop
João A. C. Lima
John H. Reid
Edwin J. R. van Beek
Dilip Patel
David E. Newby
Publication date: 01-03-2017
Publisher: Springer Berlin Heidelberg
Published in: European Radiology / Issue 3/2017
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI: https://doi.org/10.1007/s00330-016-4404-5

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Computed tomography myocardial perfusion vs ¹⁵O-water positron emission tomography and fractional flow reserve

Abstract

Objectives

Methods

Results

Conclusion

Key Points

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Objectives

Methods

Results

Conclusion

Key Points

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