Diagnostic accuracy of 13N-ammonia myocardial perfusion imaging with PET-CT in the detection of coronary artery disease

Abstract

Background: 13 N-ammonia positron emission tomography-computed tomography (PET-CT) is being increasingly used as a non-invasive imaging modality for evaluating patients with known or suspected coronary artery disease (CAD), but information about the diagnostic accuracy of PET-MPI is sparse. Objectives: Our objective was to determine the accuracy of 13 N-ammonia PET-CT myocardial perfusion imaging (MPI) for detecting CAD. Methods: We retrospectively evaluated 383 patients with suspected CAD who underwent rest-stress 13 Nammonia PET-CT MPI. Invasive coronary angiography (ICA) was performed within 60 days for all patients with abnormal PET-MPI findings and for selected patients with normal PET-MPI findings. Results: The mean age of the patients was 64±11 years, and the mean body mass index was 32±7 kg/m 2. Stress perfusion defects were identified in 147 (34%) out of a total of 383 patients. ICA was performed in 213 patients (145 patients with abnormal PET and 68 patients with normal PET). The sensitivity of PET-MPI for detection of obstructive CAD based on ≥50% stenosis was 90%; specificity, 90%; positive predictive value, 96%; negative predictive value, 76%; and diagnostic accuracy, 80%. Conclusions: PET-MPI with 13 N-ammonia affords high sensitivity and overall accuracy for detecting CAD. The addition of coronary artery calcium score (CACS) can improve CAD risk stratification.

13N-ammonia positron emission tomography-derived endocardial strain for the assessment of ischemia using feature-tracking in high-resolution cine imaging

“…13 N-ammonia PET is essential for assessing myocardial blood flow at rest, hyperemia-induced adenosine stress, and coronary flow reserve. Patients with myocardial ischemia can be assessed using the PET-derived summed stress score, summed rest score, summed difference score, myocardial flow reserve (MFR), and stressed:resting ratio of the myocardial blood flow (1)(2)(3)(4)(5). Contours of the myocardium, including the left ventricular (LV) papillary muscle, can also be clearly visualized using a PET-computed tomography scanner equipped with time-of-flight correction (6).…”

Virtual myocardial PET generated from deep learning of SPECT and PET datasets: potential for attenuation correction in CT-less SPECT

“…Because dedicated cardiac SPECT scanners are designed compactly without CT, attenuation correction with deep-learning based on attenuation-corrected SPECT as a training dataset is challenging (22). Myocardial PET has become widely available for a quantitative assessment of MFR (23)(24)(25)(26). This proposed method may be promising for applying to the CZT-SPECT system by preparing patient-to-patient datasets of PET and CZT-SPECT.…”

Findings of Cardiovascular Workup of Kidney Transplant Candidates: A Retrospective Study of a Single-Center in Saudi Arabia

“…The incidence of myocardial perfusion defects was only 13%. 41 However patients with established CAD (having prior percutaneous coronary intervention, coronary bypass surgery, or prior myocardial infarction) were excluded. Of note, PET-CT imaging has a much higher sensitivity over SPECT for the diagnosis of CAD.…”