J Korean Soc Radiol.  2011 Jun;64(6):541-551. 10.3348/jksr.2011.64.6.541.

Evaluation of Agreement between 64-slice Computed Tomography Angiography and 201-Tl Single Photon Emission Computed Tomography-myocardial Perfusion Imaging in the Diagnosis of Significant Coronary Artery Disease

• Ma JH
• Kang DK
• Lee SJ
• An YS
• Lim HS

• KMID: 1443503
• DOI: http://doi.org/10.3348/jksr.2011.64.6.541

Abstract

PURPOSE
To compare coronary computed tomography angiography (CTA) with single photon emission computed tomography-myocardial perfusion imaging (SPECT-MPI) for the detection of physiologically significant coronary artery disease (CAD).
MATERIALS AND METHODS
We evaluated 202 patients undergoing 64-slice coronary CTA and 201-Tl SPECT-MPI within a 3-month time interval. In addition, 68 patients underwent invasive coronary angiography (ICA). Coronary artery stenoses with luminal narrowing > or =50% were defined as "significant" on CTA and ICA. All myocardial segments were classified as reversible or fixed perfusion defects and normal segments on 201-Tl SPECT-MPI, and were allocated to the corresponding coronary vessels. Agreement and diagnostic performance between each imaging modality for physiologically significant CAD was calculated using the kappa (kappa) statistic and receiver operating characteristic analysis, respectively.
RESULTS
The sensitivity and specificity of CTA for the detection of physiologically significant CAD were 88% and 86% by patient-based analysis, and 84% and 91% by vessel-based analysis as compared to 201-Tl SPECT-MPI, respectively. The agreement between CTA and SPECTMPI was good (kappa = 0.647) and moderate (kappa = 0.558) by patient- and vessel-based analyses, respectively. The accuracy of CTA for predicting perfusion defects on SPECT-MPI was comparable (area under the curve; 0.814 vs. 0.819, p=0.902 on patient-based analysis, and 0.808 vs. 0.749, p=0.197 on vessel-based analysis) to ICA.
CONCLUSION
Coronary stenosis > or =50% on coronary CTA shows good agreement with perfusion defects in SPECT-MPI.

MeSH Terms

Angiography
Coronary Angiography
Coronary Artery Disease
Coronary Stenosis
Coronary Vessels
Humans
Myocardial Perfusion Imaging
Perfusion
Perfusion Imaging
Phenobarbital
ROC Curve
Sensitivity and Specificity
Tomography, X-Ray Computed
Phenobarbital

Figure

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  Fig. 1 A. CTA of a 49-year-old female showing tubular significant stenosis at the mid-LAD due to soft plaque. B. A large-sized, moderate-to-severe perfusion defect in the LAD territory on SPECT. C. ICA revealing significant luminal narrowing of the LAD.

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  Fig. 2 A, B. CTA of an 80-year-old male with intermediate CAD risk showing multifocal calcified plaques, but no significant stenoses. C. SPECT suggesting possible myocardial ischemia in the apical inferior wall.

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  Fig. 3 Receiver operating curve of each diameter stenosis cut-off for predicting perfusion defect on SPECT-MPI shows the highest AUC for cut-off ≥ 50% (0.878) compared to cut-off of ≥ 70% (0.693) and ≥ 90% (0.607).

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  Fig. 4 A. A discrete significant stenosis at the proximal LAD with soft plaque on CTA in a 61-year-old male patient. B. SPECT-MPI showing no significant perfusion defects. C. This patient underwent ICA for further evaluation and diagnosed with significant stenosis at the LAD.

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