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CLINICAL RESEARCH: CARDIAC IMAGING

Diagnostic Accuracy of Rubidium-82 Myocardial Perfusion Imaging With Hybrid Positron Emission Tomography/Computed Tomography in the Detection of Coronary Artery Disease

Uchechukwu K. Sampson, MD, MPH, MBA, MSc(Oxon)^_*, Sharmila Dorbala, MD, FACC^_*,, Atul Limaye, MD, MRCP^_*, Raymond Kwong, MD^_*, and Marcelo F. Di Carli, MD, FACC, FAHA^_*,,_*

^_* Divisions of Nuclear Medicine and Cardiovascular Imaging, Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
Division of Cardiology, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts.

Manuscript received April 26, 2006; revised manuscript received August 21, 2006, accepted August 28, 2006.

^_* Reprint requests and correspondence: Dr. Marcelo F. Di Carli, Division of Nuclear Medicine/PET, Department of Radiology, Brigham and Women’s Hospital, 75 Francis Street, Boston, Massachusetts 02115. (Email: mdicarli{at}partners.org).

Objectives: Our objective was to determine the accuracy of rubidium-82 myocardial perfusion positron emission tomography-computed tomography (PET-CT) imaging for detecting obstructive coronary artery disease (CAD).

Background: Hybrid PET-CT is a new noninvasive imaging modality for evaluating patients with known or suspected CAD.

Methods: We evaluated 64 consecutive patients with suspected CAD undergoing rest-stress rubidium-82 cardiac PET-CT (CT was only used for attenuation correction) and coronary angiography within 7 days (range 1 to 180 days). Patients with known CAD, previous myocardial infarction, or revascularization were excluded. Thirty-eight patients with a low likelihood for CAD were also studied. Obstructive CAD was defined as 70% diameter stenosis on angiography.

Results: The mean age of the patients was 62 ± 15 years, with a body mass index of 31 ± 8 kg/m². Chest pain and/or dyspnea were the predominant reasons for evaluation. Stress perfusion defects were detected in 41 of 44 patients with obstructive CAD (sensitivity 93%, 95% confidence interval [CI] 87 to 99). The specificity of PET-CT was 83% (48 of 58, 95% CI 71 to 91), and its overall diagnostic accuracy was 87% (95% CI 79 to 93). All patients with a low likelihood for CAD showed normal scans, for a normalcy rate of 100% (38 of 38, 95% CI 91 to 100). The sensitivity for detecting CAD in patients with single and multivessel (2 vessels) disease was 92% (22 of 24, 95% CI 74 to 99) and 95% (19 of 20, 95% CI 74 to 99), respectively.

Conclusions: Myocardial perfusion PET-CT affords high sensitivity and overall accuracy for detecting CAD, including patients with single-vessel disease, women, and obese patients.

Abbreviations and Acronyms   BMI = body mass index   CAD = coronary artery disease   CI = confidence interval   CT = computed tomography   MI = myocardial infarction   PET = positron emission tomography   SPECT = single-photon emission computed tomography

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