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European Journal of Nuclear Medicine and Molecular Imaging
Published in: European Journal of Nuclear Medicine and Molecular Imaging 8/2016

01-07-2016 | Original Article

Segmental quantitative myocardial perfusion with PET for the detection of significant coronary artery disease in patients with stable angina

Authors: Valentina Berti, Roberto Sciagrà, Danilo Neglia, Mikko Pietilä, Arthur J. Scholte, Stephan Nekolla, François Rouzet, Alberto Pupi, Juhani Knuuti

Published in: European Journal of Nuclear Medicine and Molecular Imaging | Issue 8/2016

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Abstract

Purpose

The goal of this study is to determine the technical accuracy of segmental perfusion parameters assessed with quantitative cardiac PET imaging in the evaluation of coronary artery disease (CAD) in patients with stable angina.

Methods

A cohort of patients who participated in the EVINCI protocol underwent an evaluation of coronary anatomy by invasive coronary angiography (ICA) and/or coronary computed tomography angiography (CCTA) and PET myocardial perfusion imaging with H2 15O, 13NH3 or 82Rb. PET studies were analyzed by two independent observers blinded to clinical and instrumental data, and classified as positive or negative for significant CAD using only segmental perfusion measurements and cut-off values from literature.

Results

On a per-patient basis, the overall inter-observer agreement on PET results was 90 % (kappa = 0.79), indicating substantial agreement. On a per-vessel basis, the inter-observer agreement on PET results was 88 % (kappa = 0.74) in the RCA territory, 94 % (kappa = 0.84) in the LAD territory and 94 % (kappa = 0.85) in the LCX territory.
Segmental PET measurements correctly identified 85 % of the patients, resulting in a global sensitivity of 86 %, a specificity of 84 %, a positive predictive value (PPV) of 69 % and a negative predictive value (NPV) of 93 %.
In vessel-based analyses, quantitative perfusion parameters had a sensitivity, specificity, PPV and NPV of 92 %, 82 %, 42 % and 99 %, respectively, for the detection of significant coronary stenoses in all major coronary arteries.

Conclusions

The assessment of absolute myocardial perfusion parameters measured at a segment level lead to reliable and accurate identification of patients with significant coronary stenosis at ICA and/or CCTA.
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Metadata
Title
Segmental quantitative myocardial perfusion with PET for the detection of significant coronary artery disease in patients with stable angina
Authors
Valentina Berti
Roberto Sciagrà
Danilo Neglia
Mikko Pietilä
Arthur J. Scholte
Stephan Nekolla
François Rouzet
Alberto Pupi
Juhani Knuuti
Publication date
01-07-2016
Publisher
Springer Berlin Heidelberg
Published in
European Journal of Nuclear Medicine and Molecular Imaging / Issue 8/2016
Print ISSN: 1619-7070
Electronic ISSN: 1619-7089
DOI
https://doi.org/10.1007/s00259-016-3362-0

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