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.
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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 |
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