Myocardial CT Perfusion Imaging and SPECT for the Diagnosis of Coronary Artery Disease: A Head-to-Head Comparison from the CORE320 Multicenter Diagnostic Performance Study

Abstract

Purpose:To compare the diagnostic performance of myocardial computed tomographic (CT) perfusion imaging and single photon emission computed tomography (SPECT) perfusion imaging in the diagnosis of anatomically significant coronary artery disease (CAD) as depicted at invasive coronary angiography. Materials and Methods:This study was approved by the institutional review board. Written informed consent was obtained from all patients. Sixteen centers enrolled 381 patients from November 2009 to July 2011. Patients underwent rest and adenosine stress CT perfusion imaging and rest and either exercise or pharmacologic stress SPECT before and within 60 days of coronary angiography. Images from CT perfusion imaging, SPECT, and coronary angiography were interpreted at blinded, independent core laboratories. The primary diagnostic parameter was the area under the receiver operating characteristic curve (A z ). Sensitivity and specificity were calculated with use of prespecified cutoffs.The reference standard was a stenosis of at least 50% at coronary angiography as determined with quantitative methods. Results:CAD was diagnosed in 229 of the 381 patients (60%). The per-patient sensitivity and specificity for the diagnosis of CAD (stenosis 50%) were 88% (202 of 229 patients) and 55% (83 of 152 patients), respectively, for CT perfusion imaging and 62% (143 of 229 patients) and 67% (102 of 152 patients) for SPECT, with A z values of 0.78 (95% confidence interval: 0.74, 0.82) and 0.69 (95% confidence interval: 0.64, 0.74) (P = .001). The sensitivity of CT perfusion imaging for single-and multivessel CAD was higher than that of SPECT, with sensitivities for left main, threevessel, two-vessel, and one-vessel disease of 92%, 92%, 89%, and 83%, respectively, for CT perfusion imaging and 75%, 79%, 68%, and 41%, respectively, for SPECT. Conclusion:The overall performance of myocardial CT perfusion imaging in the diagnosis of anatomic CAD (stenosis 50%), as demonstrated with the A z , was higher than that of SPECT and was driven in part by the higher sensitivity for left main and multivessel disease.q RSNA, 2014

Cardiac CT vs. Stress Testing in Patients with Suspected Coronary Artery Disease: Review and Expert Recommendations

“…The combination of CCTA and CTP has increased diagnostic accuracy of CCTA for the diagnosis of hemodynamically significant coronary stenosis [63–65]. CT myocardial stress perfusion imaging has recently been shown to be more accurate than SPECT for the diagnosis of CAD [66]. Combining CTA and CTP yielded and AUC of 0.87 for predicting CAD by conventional angiography which was associated with a corresponding myocardial perfusion defect by SPECT [67].…”

Fractional Flow Reserve and Coronary Computed Tomographic Angiography

“…54 There are extensive CTP data favorably comparing its accuracy to ICA, MPI, and stress MRI for the detection of >50% stenosis by ICA. [55][56][57][58] The ability to reduce false-positive findings by discounting perfusion abnormalities in the distribution of normal vessels offers an advantage over the other functional tests, all of which lack an anatomic component. There are several studies comparing CTP with invasive FFR (Table 4).…”

The dream of a one-stop-shop: Meta-analysis on myocardial perfusion CT

“…In the CORE320 study, George et al showed that the diagnostic performance of single-phase stress perfusion CT imaging is higher than that of SPECT for the identification of patients with a stenosis of more than 50% on ICA, an improvement mostly driven by a higher sensitivity of CT [25]. Interestingly, the combination of single-phase stress CT with CTA provided even better diagnostic accuracy in several studies, which makes combination of these techniques into one scan examination promising for future patient workup [22,[36][37][38].…”