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

Abstract

Objective:We determined the diagnostic performance of stress dual-energy computed tomography-myocardial perfusion imaging (DECT-MPI) for diagnosing coronary artery stenoses causing ischemia. Materials and Methods:Institutional review board approval and informed patient consent were obtained before patient enrollment in the study. One hundred ninety-two consecutive patients (135 males, 63.1±8.0 years) underwent coronary computed tomography angiography (CCTA), stress DECT-MPI, and a combined invasive coronary angiography (ICA)/cardiac magnetic resonance-myocardial perfusion imaging (CMR-MPI) for further comparison. Stress DECT-MPI and CMR-MPI were evaluated for perfusion deficits, whereas CCTA and ICA were evaluated for coronary stenosis ≥50%. The primary endpoint was the diagnostic performance of combined CCTA/stress DECT-MPI compared with combined ICA/CMR-MPI at the per-vessel level. Individual direct comparisons of CCTA to ICA and stress DECT-MPI to CMR-MPI were explored. Results:One hundred forty-four (75%) patients and 257 (45%) vascular territories manifested ischemia-causing coronary stenoses based on combined ICA/CMR-MPI. Per-vessel sensitivity, specificity, positive predictive value, and negative predictive value of combined CCTA/stress DECT-MPI were 88, 82, 79, and 89%, respectively, compared with combined ICA/ CMR-MPI. The values for CCTA alone were 95, 45, 63, and 94%, respectively, and the values for stress DECT-MPI alone were 91, 75, 75, and 92%, respectively. The area under the receiver operating characteristics curve for combined CCTA/stress DECT-MPI was higher than that for CCTA alone (0.85 vs. 0.75, p=0.001). Conclusion:When compared with combined ICA/CMR-MPI, combined CCTA/stress DECT-MPI improved the predictive value for coronary stenoses causing ischemia compared with CCTA, but only mildly improved the diagnostic performance of stress DECT-MPI alone.