Comparison of the Extent and Severity of Myocardial Perfusion Defects Measured by CT Coronary Angiography and SPECT Myocardial Perfusion Imaging (original) (raw)
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Direct comparison of rest and adenosine stress myocardial perfusion CT with rest and stress SPECT
Journal of Nuclear Cardiology, 2010
Introduction-We have recently described a technique for assessing myocardial perfusion using adenosine-mediated stress imaging (CTP) with dual source computed tomography. SPECT myocardial perfusion imaging (SPECT-MPI) is a widely utilized and extensively validated method for assessing myocardial perfusion. The aim of this study was to determine the level of agreement between CTP and SPECT-MPI at rest and under stress on a per-segment, per-vessel, and per-patient basis.
The American Journal of Cardiology, 2005
The incremental prognostic value of combined regional wall motion and perfusion over perfusion alone by gated single-photon emission computed tomographic myocardial perfusion scintigraphy has not been evaluated. Of the 402 consecutive patients who underwent stress single-photon emission computed tomographic myocardial perfusion scintigraphy for suspected myocardial ischemia, we identified 333 patients (217 men, mean age 63 ؎ 10 years; exercise in 249 and dipyridamole adminstered to 84). Visual scoring of perfusion images and regional wall motion used 20 segments and a scale of 0 to 4. Resting and poststress left ventricular ejection fraction was automatically generated. On follow-up (median 13 months), 30 hard cardiac events (17 cardiac deaths, 13 nonfatal acute myocardial infarctions) and 66 total cardiac events (including hard events, 26 with unstable angina, and 10 who underwent late revascularization) occurred. After adjustment for pre-scan information, the best independent predictors of hard events were summed stress score for wall motion (Wald's chi-square 8.3, p <0.004) and several vascular territories with ischemia by perfusion/function (Wald's chi-square 6.2, p <0.01). The strongest predictors of all cardiac events were the number of ischemias (Wald's chi-square 32.1, p <0.0001) and the number of ischemic vascular territories by perfusion (Wald's chi-square 13.1, p <0.0001). Addition of function data to the combined model of perfusion data yielded an incremental value of 26% for predicting hard events but not for all events. In conclusion, the assessment of combined perfusion/function provides incremental prognostic information for further hard events with perfusion data alone; perfusion data best predict all cardiac events.
Stress myocardial perfusion imaging using computed tomography in stable coronary artery disease
2017
Under the Copyright Act 1968, this thesis must be used only under the normal conditions of scholarly fair dealing. In particular no results or conclusions should be extracted from it, nor should it be copied or closely paraphrased in whole or in part without the written consent of the author. Proper written acknowledgement should be made for any assistance obtained from this thesis. Notice 2 I certify that I have made all reasonable efforts to secure copyright permissions for third-party content included in this thesis and have not knowingly added copyright content to my work without the owner's permission. THESIS CONTENTS Chapter 3: 320 detector row CT coronary angiography as a gatekeeper to defer referrals for invasive angiography and revascularisation in stable coronary artery disease Chapter 4: CT stress myocardial perfusion imaging using multidetector CT-a review Chapter 5: Computed tomography stress myocardial perfusion imaging in patients considered for revascularisation: a comparison with fractional flow reserve Chapter 6: Combined CT coronary angiography and stress myocardial perfusion imaging for hemodynamically significant stenoses in patients with suspected coronary artery disease Chapter 7: Deciphering the role of cardiac computed tomography in interventional cardiology: 2012 and beyond Chapter 8: Conclusion and future directions 1 Chapter 2: A new algorithm for the management of stable coronary artery disease incorporating CT coronary angiography and fractional flow reserve: how we can improve outcomes and reduce costs Chapter 1: Introduction and aims of thesis 28-34
Circulation Journal, 2011
Background: The aim of the present study was to assess semi-quantification of myocardial perfusion using adenosine triphosphate (ATP)-stress myocardial perfusion computed tomography (MPCT) in patients with coronary artery disease (CAD). Methods and Results: Seventeen patients with CAD underwent ATP-stress MPCT, stress myocardial perfusion scintigraphy (MPS) and coronary angiography (CAG). With ATP loading (0.16 mg • kg-1 • min-1 , 5 min) and slow infusion of contrast medium (2 ml/s, 100 ml), stress images were acquired using prospective electrocardiogram-gated 64-slice CT. Stress MPCT images were analyzed according to the transmural perfusion gradient (TMPG; difference between subendocardial and epicardial attenuation, divided by wall thickness; Hounsfield units [HU]/mm) per segment, and summed TMPG was compared with those of stress MPS and CAG per territory and patient, respectively. There were 36 CAG-proved stenotic vessels in 51 (17×3) territories. There were significant correlations between TMPG and MPS stress score per segment, per territory and per patient, respectively (P<0.05). Summed TMPG in territories with and without >70% coronary stenosis was 32.3 HU/mm (-1.9~90.9) and 14.5 HU/mm (-5.6~38.4; P<0.05). For detecting coronary artery stenosis, sensitivity, specificity, positive and negative predictive values using the summed TMPG were 72%, 87%, 93% and 57%, in comparison with summed MPS (64%, 73%, 85%, and 46%). Conclusions: Semi-quantification of myocardial perfusion using TMPG has great potential to evaluate the severity of myocardial ischemia, similarly to MPS score.
2007
Background: Real-time perfusion (RTP) adenosine stress echocardiography (ASE) can be used to visually evaluate myocardial ischaemia. The RTP power modulation technique, provides images for off-line parametric perfusion quantification using Qontrast Ò software. From replenishment curves, this generates parametric images of peak signal intensity (A), myocardial blood flow velocity (b) and myocardial blood flow (Axb) at rest and stress. This may be a tool for objective myocardial ischaemia evaluation. We assessed myocardial ischaemia by RTP-ASE Qontrast Ò -generated images, using 99mTc-tetrofosmin single-photon emission computed tomography (SPECT) as reference. Methods: Sixty-seven patients admitted to SPECT underwent RTP-ASE (SONOS 5500) during Sonovue Ò infusion, before and throughout adenosine stress, also used for SPECT. Quantitative off-line analyses of myocardial perfusion by RTP-ASE Qontrast Ò -generated A, b and Axb images, at different time points during rest and stress, were blindly compared to SPECT. Results: We analysed 201 coronary territories [corresponding to the left anterior descendent (LAD), left circumflex (LCx) and right coronary (RCA) arteries] from 67 patients. SPECT showed ischaemia in 18 patients. Receiver operator characteristics and kappa values showed that A, b and Axb image interpretation significantly identified ischaemia in all territories (area under the curve 0AE66-0AE80, P = 0AE001-0AE05). Combined A, b and Axb image interpretation gave the best results and the closest agreement was seen in the LAD territory: 89% accuracy; kappa 0AE63; P<0AE001. Conclusion: Myocardial isachemia can be evaluated in the LAD territory using RTP-ASE Qontrast Ò -generated images, especially by combined A, b and Axb image interpretation. However, the technique needs improvements regarding the LCx and RCA territories.
Circulation journal : official journal of the Japanese Circulation Society, 2020
BACKGROUND Sequential assessment using CT coronary angiography (coronary CT) and nuclear myocardial perfusion imaging (MPI) is considered an anatomical and functional evaluation of coronary artery disease (CAD). However, there can be unexpected radiation exposure. Hybrid MPI with stress-only nuclear MPI and rest CT-MPI using coronary CT may contribute to reducing the radiation dose in sequential assessment with nuclear MPI after coronary CT. We analyzed the diagnostic performance and total radiation dose of hybrid MPI for detection of significant CAD compared with sequential assessment using nuclear MPI after coronary CT.Methods and Results:The results for 101 patients who underwent coronary CT, nuclear MPI and invasive coronary angiography within 3 months of all imaging were analyzed. We calculated the summed difference score (SDS) from standard nuclear MPI and hybrid SDS from hybrid MPI, which revealed myocardial ischemia. The diagnostic performance of SDS and hybrid SDS for detec...