HOME SUBSCRIPTIONS CURRENT ISSUE PAST ISSUES CARDIOSOURCE SEARCH HELP FEEDBACK		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Figures Only Full Text Full Text (PDF) All Versions of this Article: j.jacc.2006.10.069v1 49/10/1059    most recent Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via ISI Web of Science (20) Citing Articles via Google Scholar Google Scholar Articles by Rispler, S. Articles by Israel, O. Search for Related Content PubMed Articles by Rispler, S. Articles by Israel, O. Related Collections Related Article

CLINICAL RESEARCH: CARDIAC IMAGING

Integrated Single-Photon Emission Computed Tomography and Computed Tomography Coronary Angiography for the Assessment of Hemodynamically Significant Coronary Artery Lesions

Shmuel Rispler, MD, PhD^_*,,_*, Zohar Keidar, MD, PhD, Eduard Ghersin, MD, Ariel Roguin, MD, PhD, Adrian Soil^||,2, Robert Dragu, MD^_*, Diana Litmanovich, MD, Alex Frenkel, DSc, Doron Aronson, MD^_*, Ahuva Engel, MD, Rafael Beyar, MD, DSc, FACC and Ora Israel, MD^,1

^_* Department of Cardiology, Technion-Israel Institute of Technology, Haifa, Israel
Department of Nuclear Medicine, Technion-Israel Institute of Technology, Haifa, Israel
Department of Medical Imaging, Technion-Israel Institute of Technology, Haifa, Israel
Division of Invasive Cardiology, Rambam Health Care Campus and the B. Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
^|| Functional Imaging, General Electric Healthcare Technologies, Tirat Hacarmel, Israel.

Manuscript received June 29, 2006; revised manuscript received August 31, 2006, accepted October 18, 2006.

^_* Reprint requests and correspondence: Dr. Shmuel Rispler, Department of Nuclear Medicine, Rambam Medical Center, Haifa 31096, Israel. (Email: s_rispler{at}rambam.health.gov.il).

Objectives: The purpose of this study was to assess the physiologic significance of coronary artery lesions with an integrated single-photon emission computed tomography (SPECT) and computed tomography coronary angiography (CTCA) device.

Background: Myocardial perfusion imaging (MPI) with SPECT is of value for assessing the physiologic significance of coronary lesions. Computed tomography coronary angiography is a new technique to noninvasively detect coronary stenosis, with high sensitivity and negative predictive value (NPV) but lower specificity and positive predictive value (PPV). The experimental SPECT/CTCA hybrid imaging device (Infinia gamma camera and LightSpeed16 CT, General Electric, Milwaukee, Wisconsin) enables concurrent assessment of coronary anatomy and myocardial perfusion.

Methods: Fifty-six patients with angina pectoris underwent single-session SPECT-MPI and CTCA with the hybrid device and coronary angiography (CA) within 4 weeks. The ability of fused SPECT/CTCA images to diagnose physiologically significant lesions showing >50% stenosis and reversible perfusion defects in the same territory was determined and compared with CTCA stand-alone.

Results: Of a total of 224 coronary segments in 56 patients, 12 patients and 54 segments (23%) were excluded from further analysis of CTCA. Overall, 170 coronary segments were evaluated. The sensitivity, specificity, PPV, and NPV of CTCA were 96%, 63%, 31%, and 99%, respectively, as compared with 96%, 95%, 77%, and 99%, respectively, for SPECT/CTCA.

Conclusions: Hybrid SPECT/CTCA imaging results in improved specificity and PPV to detect hemodynamically significant coronary lesions in patients with chest pain. Single-photon emission computed tomography/CTCA might play a potentially important role in the noninvasive diagnosis of coronary artery disease and introduce an objective decision-making tool for assessing the need for interventions in each occluded vessel.

Abbreviations and Acronyms   CA = coronary angiography   CAD = coronary artery disease   CRX = left circumflex coronary artery   CTCA = computed tomography coronary angiography   LAD = left anterior descending coronary artery   LMCA = left main coronary artery   LV = left ventricle   MPI = myocardial perfusion imaging   NPV = negative predictive value   PPV = positive predictive value   RCA = right coronary artery   SPECT = single-photon emission computed tomography

Related Article

Anatomic-Functional Imaging by Single-Photon Emission Computed Tomography/Computed Tomography as the Cornerstone of Diagnosis and Treatment for Coronary Patients: A Glimpse Into the (Near) Future?

William Wijns
J. Am. Coll. Cardiol. 2007 49: 1068-1070. [Full Text] [PDF]

This article has been cited by other articles:

				B. Kantor, N. S. Anavekar, and T. C. Gerber Good news on coronary computed tomographic angiography: answers that have questions! Eur. Heart J., September 1, 2008; 29(17): 2070 - 2072. [Full Text] [PDF]

				W. B. Meijboom, C. A.G. Van Mieghem, N. van Pelt, A. Weustink, F. Pugliese, N. R. Mollet, E. Boersma, E. Regar, R. J. van Geuns, P. J. de Jaegere, et al. Comprehensive Assessment of Coronary Artery Stenoses: Computed Tomography Coronary Angiography Versus Conventional Coronary Angiography and Correlation With Fractional Flow Reserve in Patients With Stable Angina J. Am. Coll. Cardiol., August 19, 2008; 52(8): 636 - 643. [Abstract] [Full Text] [PDF]

				A. K. Buck, S. Nekolla, S. Ziegler, A. Beer, B. J. Krause, K. Herrmann, K. Scheidhauer, H.-J. Wester, E. J. Rummeny, M. Schwaiger, et al. SPECT/CT J. Nucl. Med., August 1, 2008; 49(8): 1305 - 1319. [Abstract] [Full Text] [PDF]

				J. D Schuijf and J. J Bax CT angiography: an alternative to nuclear perfusion imaging? Heart, March 1, 2008; 94(3): 255 - 257. [Full Text] [PDF]

				S. Schroeder, S. Achenbach, F. Bengel, C. Burgstahler, F. Cademartiri, P. de Feyter, R. George, P. Kaufmann, A. F. Kopp, J. Knuuti, et al. Cardiac computed tomography: indications, applications, limitations, and training requirements: Report of a Writing Group deployed by the Working Group Nuclear Cardiology and Cardiac CT of the European Society of Cardiology and the European Council of Nuclear Cardiology Eur. Heart J., February 2, 2008; 29(4): 531 - 556. [Abstract] [Full Text] [PDF]

				A. N. DeMaria, J. J. Bax, O. Ben-Yehuda, P. Clopton, G. K. Feld, G. S. Ginsburg, B. H. Greenberg, J. D. Knoke, W. Y.W. Lew, J. A.C. Lima, et al. Highlights of the year in JACC 2007. J. Am. Coll. Cardiol., January 29, 2008; 51(4): 490 - 512. [Full Text] [PDF]

				T. C. Gerber, B. Kantor, and P. Chareonthaitawee Coronary computed tomographic angiography and exercise electrocardiography: a great match or unequal partners? Eur. Heart J., August 1, 2007; 28(15): 1787 - 1789. [Full Text] [PDF]

				M. F. Di Carli, S. Dorbala, J. Meserve, G. El Fakhri, A. Sitek, and S. C. Moore Clinical Myocardial Perfusion PET/CT J. Nucl. Med., May 1, 2007; 48(5): 783 - 793. [Abstract] [Full Text] [PDF]

				W. Wijns Anatomic-Functional Imaging by Single-Photon Emission Computed Tomography/Computed Tomography as the Cornerstone of Diagnosis and Treatment for Coronary Patients: A Glimpse Into the (Near) Future? J. Am. Coll. Cardiol., March 13, 2007; 49(10): 1068 - 1070. [Full Text] [PDF]