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European Journal of Nuclear Medicine and Molecular Imaging
Published in: European Journal of Nuclear Medicine and Molecular Imaging 4/2018

01-04-2018 | Original Article

Combined evaluation of regional coronary artery calcium and myocardial perfusion by 82Rb PET/CT in the identification of obstructive coronary artery disease

Authors: Emilia Zampella, Wanda Acampa, Roberta Assante, Carmela Nappi, Valeria Gaudieri, Ciro Gabriele Mainolfi, Roberta Green, Valeria Cantoni, Mariarosaria Panico, Michele Klain, Mario Petretta, Piotr J. Slomka, Alberto Cuocolo

Published in: European Journal of Nuclear Medicine and Molecular Imaging | Issue 4/2018

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Abstract

Purpose

Cardiac imaging with PET/CT allows measurement of coronary artery calcium (CAC), myocardial perfusion and coronary vascular function. We investigated whether the combined assessment of regional CAC score, ischemic total perfusion deficit (ITPD) and quantitative coronary vascular function would further improve the diagnostic accuracy of PET/CT in predicting obstructive coronary artery disease (CAD).

Methods

We analyzed 113 patients with suspected CAD referred to 82Rb PET/CT myocardial perfusion imaging with available coronary angiographic data. Obstructive CAD was defined as ≥75% stenosis. The receiver operating characteristic area under curve (AUC) was applied to evaluate the ability of CAC score, ITPD, hyperemic myocardial blood flow (MBF) and coronary flow reserve (CFR) to identify CAD.

Results

Vessels with obstructive CAD (71 vessels) had higher ITPD (4.6 ± 6.2 vs. 0.6 ± 1.3) and lower hyperemic MBF (1.01 ± 0.5 vs. 1.75 ± 0.6 ml/min/g) and CFR (1.56 ± 0.6 vs. 2.38 ± 0.7; all p < 0.001) than those without. In prediction of per-vessel CAD, the AUCs for the models including CAC/ITPD/hyperemic MBF (0.869) and CAC/ITPD/CFR (0.875) were higher (both p < 0.01) than for the model including CAC/ITPD (0.790). Compared with CAC/ITPD, continuous net reclassification improvement was 0.69 (95% bootstrap confidence interval, CI, 0.365–1.088) for the CAC/ITPD/hyperemic MBF model and 0.99 (95% bootstrap CI 0.64–1.26) for the CAC/ITPD/CFR model.

Conclusion

Hyperemic MBF and CFR provide incremental information about the presence of CAD over CAC score and perfusion imaging parameters. The combined use of CAC, myocardial perfusion imaging and quantitative coronary vascular function in may help predict more accurately the presence of obstructive CAD.
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Metadata
Title
Combined evaluation of regional coronary artery calcium and myocardial perfusion by 82Rb PET/CT in the identification of obstructive coronary artery disease
Authors
Emilia Zampella
Wanda Acampa
Roberta Assante
Carmela Nappi
Valeria Gaudieri
Ciro Gabriele Mainolfi
Roberta Green
Valeria Cantoni
Mariarosaria Panico
Michele Klain
Mario Petretta
Piotr J. Slomka
Alberto Cuocolo
Publication date
01-04-2018
Publisher
Springer Berlin Heidelberg
Published in
European Journal of Nuclear Medicine and Molecular Imaging / Issue 4/2018
Print ISSN: 1619-7070
Electronic ISSN: 1619-7089
DOI
https://doi.org/10.1007/s00259-018-3935-1

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