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J Am Coll Cardiol, 2007; 49:1052-1058, doi:10.1016/j.jacc.2006.12.015 (Published online 23 February 2007).
© 2007 by the American College of Cardiology Foundation
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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*,{dagger}, Atul Limaye, MD, MRCP*, Raymond Kwong, MD*,{dagger} and Marcelo F. Di Carli, MD, FACC, FAHA*,{dagger},*

* Divisions of Nuclear Medicine and Cardiovascular Imaging, Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
{dagger} 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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