CLINICAL RESEARCH: CARDIAC IMAGING
Relationship Between Noninvasive Coronary Angiography With Multi-Slice Computed Tomography and Myocardial Perfusion Imaging
Joanne D. Schuijf, MSc*, , ,
William Wijns, MD, PhD ,
J. Wouter Jukema, MD, PhD*,,
Douwe E. Atsma, MD, PhD*,
Albert de Roos, MD, PhD,
Hildo J. Lamb, MD, PhD,
Marcel P.M. Stokkel, MD, PhD||,
Petra Dibbets-Schneider, MSc||,
Isabel Decramer, MSc,¶,
Pieter De Bondt, MD, PhD#,
Ernst E. van der Wall, MD, PhD*,,
Piet K. Vanhoenacker, MD¶ and
Jeroen J. Bax, MD, PhD*,*
* Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands
The Interuniversity Institute of the Netherlands, Utrecht, the Netherlands
Cardiovascular Center, Aalst, Belgium
|| Department of Nuclear Medicine, Leiden University Medical Center, Leiden, the Netherlands
¶ Department of Radiology and Medical Imaging, OLV Ziekenhuis, Aalst, Belgium
# Division of Nuclear Medicine, OLV Ziekenhuis, Aalst, Belgium.
Manuscript received March 13, 2006;
revised manuscript received May 2, 2006,
accepted May 31, 2006.
* Reprint requests and correspondence: Dr. Jeroen J. Bax, Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, the Netherlands. (Email: jbax{at}knoware.nl).
OBJECTIVES: The aim of this study was to perform a head-to-head comparison between multi-slice computed tomography (MSCT) and myocardial perfusion imaging (MPI) in patients with an intermediate likelihood of coronary artery disease (CAD) and to compare non-invasive findings to invasive coronary angiography.
BACKGROUND: Multi-slice computed tomography detects atherosclerosis, whereas MPI detects ischemia; how these 2 techniques compare in patients with an intermediate likelihood of CAD is unknown.
METHODS: A total of 114 patients, mainly with intermediate likelihood of CAD, underwent both MSCT and MPI. The MSCT studies were classified as having no CAD, nonobstructive (<50% luminal narrowing) CAD, or obstructive CAD. Myocardial perfusion imaging examinations were classified as showing normal or abnormal (reversible and/or fixed defects). In a subset of 58 patients, invasive coronary angiography was performed.
RESULTS: On the basis of the MSCT data, 41 patients (36%) were classified as having no CAD, of whom 90% had normal MPI. A total of 33 patients (29%) showed non-obstructive CAD, whereas at least 1 significant ( 50% luminal narrowing) lesion was observed in the remaining 40 patients (35%). Only 45% of patients with an abnormal MSCT had abnormal MPI; even in patients with obstructive CAD on MSCT, 50% still had a normal MPI. In the subset of patients undergoing invasive angiography, the agreement with MSCT was excellent (90%).
CONCLUSIONS: Myocardial perfusion imaging and MSCT provide different and complementary information on CAD, namely, detection of atherosclerosis versus detection of ischemia. As compared to invasive angiography, MSCT has a high accuracy for detecting CAD in patients with an intermediate likelihood of CAD.
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Abbreviations and Acronyms
| | CAD = coronary artery disease | | MPI = myocardial perfusion imaging | | MSCT = multi-slice computed tomography | | SPECT = single-photon emission computed tomography |
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