Incremental value of combining 64-slice computed tomography angiography with stress nuclear myocardial perfusion imaging to improve noninvasive detection of coronary artery disease

Akira Sato MD, Toshihiro Nozato MD, Hiroyuki Hikita MD, Shinsuke Miyazaki MD, Yoshihide Takahashi MD, Taishi Kuwahara MD, Atsushi Takahashi MD, Michiaki Hiroe MD, Kazutaka Aonuma MD
Original Article
Volume 17, Issue 1 / February , 2010

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Abstract

Background

To compare the accuracy of combined 64-slice computed tomography angiography (CTA) and stress nuclear myocardial perfusion imaging (MPI) in the noninvasive detection of coronary artery disease (CAD) with that of 64-slice CTA alone.

Methods and results

One hundred thirty symptomatic patients with suspected CAD underwent both 64-slice CTA and stress thallium-201 MPI before invasive coronary angiography (ICA). Coronary lesions with ≥50% luminal narrowing were considered as significant stenoses on CTA and ICA. Of 390 arteries in 130 patients, 54 (14%) were nonevaluable by CTA due to severe calcifications, motion artifacts, and/or poor opacification. All nonevaluable arteries were considered positive. The sensitivity, specificity, PPV and NPV were 95%, 80%, 69%, and 97%, respectively, for CTA alone and 94%, 92%, 85%, and 97%, respectively, for CTA with stress nuclear MPI for all nonevaluable arteries on CTA. Per-patient analysis showed significant increase in specificity and PPV. The majority (75%, 9/12) of nonevaluable severely calcified vessels in the left anterior descending artery were positive on stress nuclear MPI, whereas the majority (89%, 8/9) of nonevaluable vessels with motion artifacts in the right coronary artery were negative.

Conclusions

Combined CTA and stress nuclear MPI provide improved diagnostic accuracy for the noninvasive detection of CAD.

Keywords

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