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

• DOI: 10.1007/s00330-016-4404-5
• Publication Date: 2016-06-23T00:19:43Z
• 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
• Keywords: Male; Adenosine; Computed Tomography Angiography; Vasodilator Agents; Coronary Artery Disease; Coronary Angiography; Sensitivity and Specificity; 03 medical and health sciences; 0302 clinical medicine; Oxygen Radioisotopes; Predictive Value of Tests; Humans; Prospective Studies; Aged; Coronary Stenosis; Myocardial Perfusion Imaging; Middle Aged; 3. Good health; Fractional Flow Reserve, Myocardial; Radiology Nuclear Medicine and imaging; Positron-Emission Tomography; Exercise Test; Female; Tomography, X-Ray Computed; Cardiac

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