Additional value of adenosine-stress dynamic CT myocardial perfusion imaging in the reclassification of severity of coronary artery stenosis at coronary CT angiography

Aim To assess the additional value of adenosine-stress dynamic computed tomography (CT) perfusion (ASDCTP) imaging compared with coronary CT angiography (CCTA) alone to detect significant coronary artery stenosis for each threshold of 50% and 70% diameter stenosis. Materials and methods The study in...

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Bibliographic Details
Published in:Clinical radiology 2013-12, Vol.68 (12), p.e659-e668
Main Authors: Kim, S.M, Choi, J.-H, Chang, S.-A, Choe, Y.H
Format: Article
Language:English
Subjects:
Adenosine
Aged
Coronary Angiography - methods
Coronary Stenosis - classification
Coronary Stenosis - diagnostic imaging
Coronary Stenosis - pathology
Coronary Vessels - diagnostic imaging
Coronary Vessels - pathology
Exercise Test - methods
Female
Humans
Male
Myocardial Perfusion Imaging - methods
Radiology
Severity of Illness Index
Tomography, X-Ray Computed - methods
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Summary:Aim To assess the additional value of adenosine-stress dynamic computed tomography (CT) perfusion (ASDCTP) imaging compared with coronary CT angiography (CCTA) alone to detect significant coronary artery stenosis for each threshold of 50% and 70% diameter stenosis. Materials and methods The study included 34 patients (65 ± 11 years, 79% men) with suspected coronary artery diseases who underwent ASDCTP imaging using a 128-section dual-source CT (DSCT) and invasive coronary angiography (ICA). Two investigators classified coronary artery stenosis on CCTA as severe or not. If appropriate image quality could not be acquired due to artefacts, the segment was classified as a lesion with significant stenosis. After the interpretation of ASDCTP imaging, the degree of stenosis was reclassified. All parameters of diagnostic accuracy were calculated before and after ASDCTP analysis for detection of significant coronary artery stenosis with ICA as the reference standard. Results The diagnostic accuracy parameters per vessel for the detection of ≥50% stenosis before and after ASDCTP analysis changed as follows: sensitivity, from 80% to 83%; specificity, from 83% to 98%; positive predictive value (PPV), from 87% to 98%; and negative predictive value (NPV), from 75% to 80%. The addition of ASDCTP resulted in reclassification from one class of stenosis severity to another in a significant number of vessels with threshold of 50% stenosis [net reclassification improvement (NRI), 0.176; p  
ISSN:0009-9260
1365-229X
DOI:10.1016/j.crad.2013.07.015