Diagnostic performance of fusion of myocardial perfusion imaging (MPI) and computed tomography coronary angiography

Cesar A. Santana, Ernest V. Garcia, Tracy L. Faber, Gopi K R Sirineni, Fabio P. Esteves, Rupan Sanyal, Raghuveer Halkar, Mario Ornelas, Liudmila Verdes, Stamatios Lerakis, Julie J. Ramos, Santiago Aguadé-Bruix, Hugo Cuéllar, Jaume Candell-Riera, Paolo Raggi

Research output: Contribution to journalArticle

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Abstract

Background: We evaluated the incremental diagnostic value of fusion images of coronary computed tomography angiography (CTA) and myocardial perfusion imaging (MPI) over MPI alone or MPI and CTA side-by-side to identify obstructive coronary artery disease (CAD > 50% stenosis) using invasive coronary angiography (ICA) as the gold standard. Methods: 50 subjects (36 men; 56 ± 11 years old) underwent rest-stress MPI and CTA within 12-26 days of each other. CTAs were performed with multi-detector CT-scanners (31 on 64-slice; and 19 on 16-slice). 37 patients underwent ICA while 13 subjects did not because of low (<5%) pre-test likelihood (LLK) of disease. Three blinded readers scored the images in sequential sessions using (1) MPI alone (2) MPI and CTA side-by-side, (3) fused CTA/MPI images. Results: One or more critical stenoses during ICA were found in 28 patients and non-critical stenoses were found in 9 patients. MPI, side-by-side MPI-CTA, and fused CTA/MPI showed the same normalcy rate (NR:13/13) in LLK subjects. The fusion technique performed better than MPI and MPI and CTA side-by-side for the presence of CAD in any vessel (overall area under the curve (AUC) for fused images: 0.89; P = .005 vs MPI, P = .04 vs side-by-side MPI-CTA) and for localization of CAD to the left anterior descending coronary artery (AUC: 0.82, P < .001 vs MPI; P = .007 vs side-by-side MPI-CTA). There was a non-significant trend for better detection of multi-vessel disease with fusion. Conclusions: Using ICA as the gold standard, fusion imaging provided incremental diagnostic information compared to MPI alone or side-by-side MPI-CTA for the diagnosis of obstructive CAD and for localization of CAD to the left anterior descending coronary artery.

Original languageEnglish (US)
Pages (from-to)201-211
Number of pages11
JournalJournal of Nuclear Cardiology
Volume16
Issue number2
DOIs
StatePublished - 2009
Externally publishedYes

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Myocardial Perfusion Imaging
Coronary Angiography
Computed Tomography Angiography
Pathologic Constriction
Area Under Curve
Coronary Vessels

Keywords

  • Computed tomography (CT)
  • Coronary artery disease
  • Diagnostic and prognostic application
  • Myocardial perfusion imaging
  • PET imaging
  • SPECT

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Radiology Nuclear Medicine and imaging
  • Medicine(all)

Cite this

Santana, C. A., Garcia, E. V., Faber, T. L., Sirineni, G. K. R., Esteves, F. P., Sanyal, R., ... Raggi, P. (2009). Diagnostic performance of fusion of myocardial perfusion imaging (MPI) and computed tomography coronary angiography. Journal of Nuclear Cardiology, 16(2), 201-211. https://doi.org/10.1007/s12350-008-9019-z

Diagnostic performance of fusion of myocardial perfusion imaging (MPI) and computed tomography coronary angiography. / Santana, Cesar A.; Garcia, Ernest V.; Faber, Tracy L.; Sirineni, Gopi K R; Esteves, Fabio P.; Sanyal, Rupan; Halkar, Raghuveer; Ornelas, Mario; Verdes, Liudmila; Lerakis, Stamatios; Ramos, Julie J.; Aguadé-Bruix, Santiago; Cuéllar, Hugo; Candell-Riera, Jaume; Raggi, Paolo.

In: Journal of Nuclear Cardiology, Vol. 16, No. 2, 2009, p. 201-211.

Research output: Contribution to journalArticle

Santana, CA, Garcia, EV, Faber, TL, Sirineni, GKR, Esteves, FP, Sanyal, R, Halkar, R, Ornelas, M, Verdes, L, Lerakis, S, Ramos, JJ, Aguadé-Bruix, S, Cuéllar, H, Candell-Riera, J & Raggi, P 2009, 'Diagnostic performance of fusion of myocardial perfusion imaging (MPI) and computed tomography coronary angiography', Journal of Nuclear Cardiology, vol. 16, no. 2, pp. 201-211. https://doi.org/10.1007/s12350-008-9019-z
Santana, Cesar A. ; Garcia, Ernest V. ; Faber, Tracy L. ; Sirineni, Gopi K R ; Esteves, Fabio P. ; Sanyal, Rupan ; Halkar, Raghuveer ; Ornelas, Mario ; Verdes, Liudmila ; Lerakis, Stamatios ; Ramos, Julie J. ; Aguadé-Bruix, Santiago ; Cuéllar, Hugo ; Candell-Riera, Jaume ; Raggi, Paolo. / Diagnostic performance of fusion of myocardial perfusion imaging (MPI) and computed tomography coronary angiography. In: Journal of Nuclear Cardiology. 2009 ; Vol. 16, No. 2. pp. 201-211.
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abstract = "Background: We evaluated the incremental diagnostic value of fusion images of coronary computed tomography angiography (CTA) and myocardial perfusion imaging (MPI) over MPI alone or MPI and CTA side-by-side to identify obstructive coronary artery disease (CAD > 50{\%} stenosis) using invasive coronary angiography (ICA) as the gold standard. Methods: 50 subjects (36 men; 56 ± 11 years old) underwent rest-stress MPI and CTA within 12-26 days of each other. CTAs were performed with multi-detector CT-scanners (31 on 64-slice; and 19 on 16-slice). 37 patients underwent ICA while 13 subjects did not because of low (<5{\%}) pre-test likelihood (LLK) of disease. Three blinded readers scored the images in sequential sessions using (1) MPI alone (2) MPI and CTA side-by-side, (3) fused CTA/MPI images. Results: One or more critical stenoses during ICA were found in 28 patients and non-critical stenoses were found in 9 patients. MPI, side-by-side MPI-CTA, and fused CTA/MPI showed the same normalcy rate (NR:13/13) in LLK subjects. The fusion technique performed better than MPI and MPI and CTA side-by-side for the presence of CAD in any vessel (overall area under the curve (AUC) for fused images: 0.89; P = .005 vs MPI, P = .04 vs side-by-side MPI-CTA) and for localization of CAD to the left anterior descending coronary artery (AUC: 0.82, P < .001 vs MPI; P = .007 vs side-by-side MPI-CTA). There was a non-significant trend for better detection of multi-vessel disease with fusion. Conclusions: Using ICA as the gold standard, fusion imaging provided incremental diagnostic information compared to MPI alone or side-by-side MPI-CTA for the diagnosis of obstructive CAD and for localization of CAD to the left anterior descending coronary artery.",
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AU - Santana, Cesar A.

AU - Garcia, Ernest V.

AU - Faber, Tracy L.

AU - Sirineni, Gopi K R

AU - Esteves, Fabio P.

AU - Sanyal, Rupan

AU - Halkar, Raghuveer

AU - Ornelas, Mario

AU - Verdes, Liudmila

AU - Lerakis, Stamatios

AU - Ramos, Julie J.

AU - Aguadé-Bruix, Santiago

AU - Cuéllar, Hugo

AU - Candell-Riera, Jaume

AU - Raggi, Paolo

PY - 2009

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N2 - Background: We evaluated the incremental diagnostic value of fusion images of coronary computed tomography angiography (CTA) and myocardial perfusion imaging (MPI) over MPI alone or MPI and CTA side-by-side to identify obstructive coronary artery disease (CAD > 50% stenosis) using invasive coronary angiography (ICA) as the gold standard. Methods: 50 subjects (36 men; 56 ± 11 years old) underwent rest-stress MPI and CTA within 12-26 days of each other. CTAs were performed with multi-detector CT-scanners (31 on 64-slice; and 19 on 16-slice). 37 patients underwent ICA while 13 subjects did not because of low (<5%) pre-test likelihood (LLK) of disease. Three blinded readers scored the images in sequential sessions using (1) MPI alone (2) MPI and CTA side-by-side, (3) fused CTA/MPI images. Results: One or more critical stenoses during ICA were found in 28 patients and non-critical stenoses were found in 9 patients. MPI, side-by-side MPI-CTA, and fused CTA/MPI showed the same normalcy rate (NR:13/13) in LLK subjects. The fusion technique performed better than MPI and MPI and CTA side-by-side for the presence of CAD in any vessel (overall area under the curve (AUC) for fused images: 0.89; P = .005 vs MPI, P = .04 vs side-by-side MPI-CTA) and for localization of CAD to the left anterior descending coronary artery (AUC: 0.82, P < .001 vs MPI; P = .007 vs side-by-side MPI-CTA). There was a non-significant trend for better detection of multi-vessel disease with fusion. Conclusions: Using ICA as the gold standard, fusion imaging provided incremental diagnostic information compared to MPI alone or side-by-side MPI-CTA for the diagnosis of obstructive CAD and for localization of CAD to the left anterior descending coronary artery.

AB - Background: We evaluated the incremental diagnostic value of fusion images of coronary computed tomography angiography (CTA) and myocardial perfusion imaging (MPI) over MPI alone or MPI and CTA side-by-side to identify obstructive coronary artery disease (CAD > 50% stenosis) using invasive coronary angiography (ICA) as the gold standard. Methods: 50 subjects (36 men; 56 ± 11 years old) underwent rest-stress MPI and CTA within 12-26 days of each other. CTAs were performed with multi-detector CT-scanners (31 on 64-slice; and 19 on 16-slice). 37 patients underwent ICA while 13 subjects did not because of low (<5%) pre-test likelihood (LLK) of disease. Three blinded readers scored the images in sequential sessions using (1) MPI alone (2) MPI and CTA side-by-side, (3) fused CTA/MPI images. Results: One or more critical stenoses during ICA were found in 28 patients and non-critical stenoses were found in 9 patients. MPI, side-by-side MPI-CTA, and fused CTA/MPI showed the same normalcy rate (NR:13/13) in LLK subjects. The fusion technique performed better than MPI and MPI and CTA side-by-side for the presence of CAD in any vessel (overall area under the curve (AUC) for fused images: 0.89; P = .005 vs MPI, P = .04 vs side-by-side MPI-CTA) and for localization of CAD to the left anterior descending coronary artery (AUC: 0.82, P < .001 vs MPI; P = .007 vs side-by-side MPI-CTA). There was a non-significant trend for better detection of multi-vessel disease with fusion. Conclusions: Using ICA as the gold standard, fusion imaging provided incremental diagnostic information compared to MPI alone or side-by-side MPI-CTA for the diagnosis of obstructive CAD and for localization of CAD to the left anterior descending coronary artery.

KW - Computed tomography (CT)

KW - Coronary artery disease

KW - Diagnostic and prognostic application

KW - Myocardial perfusion imaging

KW - PET imaging

KW - SPECT

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