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

George, Richard Т. De; Mehra, Vishal C.; Chen, Marcus Y; Kitagawa, Kakuya; Arbab‐Zadeh, Armin; Miller, Julie M.; Matheson, Matthew B.; Vavere, Andrea L.; Kofoed, Klaus F.; Rochitte, Carlos Eduardo; Dewey, Marc; Yaw, Tan Swee; Niinuma, Hiroyuki; Brenner, Winfried; Cox, Christopher; Clouse, Melvin E.; Lima, João A.C.; Carli, Marcelo Di

doi:10.1148/radiol.14144050

Cited by 35 publications

(29 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Accordingly, a prospective multicenter international trial, the CORE 320 study (n=381), has demonstrated that static CTP imaging has a superior diagnostic accuracy respect to SPECT in detecting obstructive coronary stenosis (≥50%) as compared with ICA (47). The higher sensitivity of CTP imaging was driven in part by its higher sensitivity in the detection of left main and multivessel CAD (47). The difference in diagnostic accuracy may be attributable to the superior spatial resolution of CTP respect to SPECT in the order of submillimeter, which allows detection of subtler subendocardial perfusion defects (47).…”

Section: Ctp Imagingmentioning

confidence: 99%

“…The higher sensitivity of CTP imaging was driven in part by its higher sensitivity in the detection of left main and multivessel CAD (47). The difference in diagnostic accuracy may be attributable to the superior spatial resolution of CTP respect to SPECT in the order of submillimeter, which allows detection of subtler subendocardial perfusion defects (47). Another explanation may be the more favorable extraction characteristics of the iodinated contrast material respect to Technetium-based tracers that are susceptible to the roll-off phenomenon, allowing for a linear relationship between CT-derived metrics and MBF (47).…”

Section: Ctp Imagingmentioning

confidence: 99%

See 1 more Smart Citation

Myocardial blood flow quantification for evaluation of coronary artery disease by computed tomography

Cademartiri

Seitun

Clemente

et al. 2017

Cardiovasc. Diagn. Ther.

View full text Add to dashboard Cite

During the last decade coronary computed tomography angiography (CTA) has become the preeminent noninvasive imaging modality to detect coronary artery disease (CAD) with high accuracy.However, CTA has a limited value in assessing the hemodynamic significance of a given stenosis due to a modest specificity and positive predictive value. In recent years, different CT techniques for detecting myocardial ischemia have emerged, such as CT-derived fractional flow reserve (FFR-CT), transluminal attenuation gradient (TAG), and myocardial CT perfusion (CTP) imaging. Myocardial CTP imaging can be performed with a single static scan during first pass of the contrast agent, with monoenergetic or dualenergy acquisition, or as a dynamic, time-resolved scan during stress by using coronary vasodilator agents (adenosine, dipyridamole, or regadenoson). A number of CTP techniques are available, which can assess myocardial perfusion in both a qualitative, semi-quantitative or quantitative manner. Once used primarily as research tools, these modalities are increasingly being used in routine clinical practice. All these techniques offer the substantial advantage of combining anatomical and functional evaluation of flow-limiting coronary stenosis in the same examination that would be beneficial for clinical decision-making. This review focuses on the state-of the-art and future trends of these evolving imaging modalities in the field of cardiology for the physiologic assessments of CAD.

show abstract

Section: Ctp Imagingmentioning

confidence: 99%

Section: Ctp Imagingmentioning

confidence: 99%

Myocardial blood flow quantification for evaluation of coronary artery disease by computed tomography

Cademartiri

Seitun

Clemente

et al. 2017

Cardiovasc. Diagn. Ther.

View full text Add to dashboard Cite

show abstract

“…Cury et al [10] showed in a multicentre study that regadenoson CT-MPI was in good agreement with SPECT for detecting reversible ischaemia. Results from a sub-analysis of the CORE320 (Combined Non-invasive Coronary Angiography and Myocardial Perfusion Imaging Using 320 Detector Computed Tomography) study [11] demonstrated superior diagnostic accuracy of CT-MPI compared to SPECT for predicting obstructive CAD on ICA. Nevertheless, ICA is a suboptimal test to establish the hemodynamic severity of significant stenosis [12].…”

Section: The Role Of Ct-myocardial Perfusion Imaging (Mpi) In Obstrucmentioning

confidence: 99%

CT myocardial perfusion imaging: ready for prime time?

2017

View full text Add to dashboard Cite

The detection of functional coronary artery stenosis with coronary CT angiography (CCTA) is suboptimal. Additional CT myocardial perfusion imaging (CT-MPI) may be helpful to identify patients with myocardial ischaemia in whom coronary revascularization therapy would be beneficial. CT-MPI adds incremental diagnostic and prognostic value over obstructive disease on CCTA. It allows for the quantitation of myocardial blood flow and calculation of coronary flow reserve and shows good correlation with 15 O-H 2 O positron emission tomography and invasive fractional flow reserve. In addition, patients prefer CCTA/CT-MPI over SPECT, MRI and invasive coronary angiography. CT-MPI is ready for clinical use for detecting myocardial ischaemia caused by obstructive disease. Nevertheless, the clinical utility of CT-MPI to identify ischaemia in patients with non-obstructive/microvascular disease still has to be established. Key Points• CT-MPI can improve the positive predictive value of CCTA for lesion-specific ischaemia.• CT-MPI adds incremental prognostic value over CCTA for major adverse cardiac events.• CT-MPI correlates with 15O-H 2 O PET.• CT-MPI/CCTA shows high overall patient satisfaction.

show abstract

“…George RT et al 14 recently demonstrated the overall better sensitivity of adenosine stress myocardial CT perfusion imaging when directly compared to scintigraphic stress myocardial perfusion imaging in the diagnosis of anatomical coronary stenosis defined as C50% by invasive quantitative coronary angiography. The data, however, showed that stress CT perfusion imaging has lower positive predictive values and lower specificities at each coronary territory due to false positive results.…”

Section: See Related Article Pp 1253-1262mentioning

confidence: 99%

A multifunctional CT technology: Reality or illusion for patient risk assessment?

Nakata

2017

Journal of Nuclear Cardiology

View full text Add to dashboard Cite

A high-speed, multi-slice coronary computed tomography (CT) imaging has emerged as a promising or clinically available multifunctional technique for the assessment of myocardial ischemia, viability, ischemia-induced cardiac dysfunction, and coronary atherosclerotic alterations in patients with suspected or known coronary artery disease. Despite several technical issues remain to be resolved, cardiac CT imaging will have a reality as a multifunctional modality for guiding physicians in better decision-making for favorable clinical outcomes in patients with suspected coronary artery disease, provided that this imaging technology can contribute to characterization and localization of high-risk coronary atherosclerosis in combination with the quantitative evaluation of functional myocardial ischemia.Key Words: Myocardial ischemia AE stree myocardial perfusion imaging AE coronary artery disease AE cardiac CT See related article, pp. 1253-1262Several non-invasive modalities have emerged as promising or clinically available multifunctional techniques for the assessment of myocardial ischemia, ischemic burden size, ischemia-induced left ventricular dysfunction, myocardial viability, and high-risk coronary plaque, all of which are definitively related to unfavorable clinical outcomes in patients with suspected or known coronary artery disease. Among them, recent remarkable advances in high-speed, multi-slice computed tomography (CT) in cardiac imaging enable to evaluate not only coronary arteriosclerosis, including luminal narrowing, vulnerable plaque, and atherosclerotic remodeling, but also functional ischemia by the measurement of coronary flow reserve with or without a vasodilator agent. A wide-spread use and easy access to coronary CT at cardiology practice contributes to identifying cryptogenic coronary arteriosclerosis and vulnerable coronary plaque. On the other hand, anatomical approach to coronary artery disease tends to overestimate coronary luminal narrowing, which is not necessarily the hallmark of significant coronary artery disease or future cardiac event risks, 1-3 and sometimes results in unnecessary or ineffective selection of invasive diagnostic or therapeutic strategy. [4][5][6][7][8][9][10] In this context, cardiac CT technology as a multifunctional modality is still challenging and in progress. In this issue of J Nucl Cardiol, van Rosendael et al 11 investigated the association between atherosclerotic coronary morphology and functional ischemia both of which were estimated on the same day using a sequential CT imaging protocol together with an adenosine stress approach in 84 of 115 consecutive patients with new onset chest pain referred from the outpatient clinic. Authors demonstrated a limited but positive correlation between CT angiographic stenosis and adenosine-induced CT perfusion abnormality. Besides the small, single-center study and the limited number of ischemic lesions, there are several issues to be recognized in this study before these results can be put into clinical perspective.

show abstract

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: Figure 1: Receiver operating characteristic curves for myocardial CT perfusion imaging (CTP) and SPECT in, A, all patients and, B, only the patients who underwent pharmacologic stress SPECT.

Cited by 35 publications

References 0 publications

Myocardial blood flow quantification for evaluation of coronary artery disease by computed tomography

Myocardial blood flow quantification for evaluation of coronary artery disease by computed tomography

CT myocardial perfusion imaging: ready for prime time?

A multifunctional CT technology: Reality or illusion for patient risk assessment?

Contact Info

Product

Resources

About