Diagnostic performance of fusion of myocardial perfusion imaging (MPI) and computed tomography coronary angiography

Abstract

Background We evaluated the incremental diagnostic value of fusion images of coronary computed tomography angiography (CTA) and myocardial perfusion imaging (MPI) over MPI alone or MPI and CTA side-by-side to identify obstructive coronary artery disease (CAD > 50% stenosis) using invasive coronary angiography (ICA) as the gold standard. Methods 50 subjects (36 men; 56 ± 11 years old) underwent rest-stress MPI and CTA within 12-26 days of each other. CTAs were performed with multi-detector CT-scanners (31 on 64-slice; and 19 on 16-slice). 37 patients underwent ICA while 13 subjects did not because of low (<5%) pre-test likelihood (LLK) of disease. Three blinded readers scored the images in sequential sessions using (1) MPI alone (2) MPI and CTA side-by-side, (3) fused CTA/MPI images. Results One or more critical stenoses during ICA were found in 28 patients and non-critical stenoses were found in 9 patients. MPI, side-by-side MPI-CTA, and fused CTA/MPI showed the same normalcy rate (NR:13/13) in LLK subjects. The fusion technique performed better than MPI and MPI and CTA side-by-side for the presence of CAD in any vessel (overall area under the curve (AUC) for fused images: 0.89; P = .005 vs MPI, P = .04 vs side-by-side MPI-CTA) and for localization of CAD to the left anterior descending coronary artery (AUC: 0.82, P < .001 vs MPI; P = .007 vs side-by-side MPI-CTA). There was a non-significant trend for better detection of multi-vessel disease with fusion. Conclusions Using ICA as the gold standard, fusion imaging provided incremental diagnostic information compared to MPI alone or side-by-side MPI-CTA for the diagnosis of obstructive CAD and for localization of CAD to the left anterior descending coronary artery.

Hybrid Imaging Using Quantitative H215O PET and CT-Based Coronary Angiography for the Detection of Coronary Artery Disease

“…Fourth, although care was taken to match individual coronary anatomy to perfusion territories in the evaluation of the PET/CTCA scan, software to generate fusion images of CTCA and PET was not commercially available from the manufacturer of our installed system. Some studies have demonstrated that fused hybrid imaging as compared with side-by-side analysis may slightly improve diagnostic accuracy (34)(35)(36). Finally, parametric perfusion images were generated by different software packages developed in-house in both studies (12,37).…”

Stress Dual-Energy Computed Tomography-Myocardial Perfusion Imaging to Identify Coronary Artery Stenoses Causing Ischemia: A Direct Comparison between Invasive Coronary Angiography and Cardiac Magnetic Resonance-Myocardial Perfusion Imaging

“…SPECT-MPI and FFR are established standards for determining the functional significance of coronary stenosis inducing perfusion defects, which is valuable for guiding therapeutic plans and helping with prognostic assessments of patients [24][25][26][27][28][29]. CMR-MPI is an alternative to SPECT for detecting anatomically significant stenoses with better sensitivity and NPV compared with ICA [30].…”

Minimizing the radiation dose of CT attenuation correction while improving image quality: The case for innovation

“…In a study of 50 patients, it was demonstrated that combining MPI and CT coronary angiography increased the overall area under the curve for the presence of CAD in any vessel; however, there was no trend for increased sensitivity for multivessel CAD. 34 Although this could be seen as an improvement in the diagnostic power of a patient visit, these ''one-stop-shop'' approaches have not been embraced by the payer community and can add significantly to the patient's radiation dose.…”