Quantitative vs. qualitative evaluation of static stress computed tomography perfusion to detect haemodynamically significant coronary artery disease

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Abstract

Aims To compare the diagnostic accuracy of stress computed tomography myocardial perfusion (CTP) for the detection of significant coronary artery disease with visual approach vs. quantitative analysis with transmural perfusion ratio (TPR) in consecutive symptomatic patients scheduled for invasive coronary angiography (ICA) plus invasive fractional flow reserve (FFR). Methods and results Eighty-eight consecutive symptomatic patients underwent rest coronary computed tomography angiography (cCTA) followed by static stress-CTP. Diagnostic accuracy of cCTA + stress-CTP with visual evaluation and with TPR measurement was calculated and compared with ICA and invasive FFR. Addition of stress-CTP with qualitative evaluation to rest-cCTA showed sensitivity, specificity, negative and positive predictive values, and accuracy at a vessel and patient level of 92%, 92%, 97%, 82%, 92% and 98%, 80%, 97%, 82%, 89%, respectively indicating a significant improvement of specificity, positive predictive value, and accuracy values vs. rest-cCTA in both models. Similarly, addition of stress-CTP with TPR evaluation to rest-cCTA showed sensitivity, specificity, negative and positive predictive values, and accuracy at a vessel and patient level of 84%, 90%, 93%, 76%, 88% and 91%, 71%, 89%, 75%, 81%, respectively indicating a significant improvement of specificity, positive predictive value values vs. rest-cCTA only in a vessel-based model and of positive predictive value in a patient-based model. When cCTA + stress-CTP with qualitative evaluation was compared with cCTA + stress-CTP with TPR estimation, no differences were found in terms of diagnostic performance. Conclusion The addition of stress-CTP with visual evaluation to cCTA imaging has similar diagnostic performance when compared with the quantitative analysis of myocardial perfusion based on TPR measurement. All rights reserved.

Original languageEnglish
Pages (from-to)1244-1252
Number of pages9
JournalEuropean Heart Journal Cardiovascular Imaging
Volume19
Issue number11
DOIs
Publication statusPublished - Nov 1 2018

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Coronary Artery Disease
Perfusion
Tomography
Coronary Angiography
Computed Tomography Angiography
Sensitivity and Specificity

Keywords

  • accuracy
  • computed tomography
  • computed tomography perfusion
  • coronary artery disease
  • myocardial perfusion
  • transmural perfusion ratio

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

Cite this

@article{fb3ac2beb662469fa16979b7cfdd4826,
title = "Quantitative vs. qualitative evaluation of static stress computed tomography perfusion to detect haemodynamically significant coronary artery disease",
abstract = "Aims To compare the diagnostic accuracy of stress computed tomography myocardial perfusion (CTP) for the detection of significant coronary artery disease with visual approach vs. quantitative analysis with transmural perfusion ratio (TPR) in consecutive symptomatic patients scheduled for invasive coronary angiography (ICA) plus invasive fractional flow reserve (FFR). Methods and results Eighty-eight consecutive symptomatic patients underwent rest coronary computed tomography angiography (cCTA) followed by static stress-CTP. Diagnostic accuracy of cCTA + stress-CTP with visual evaluation and with TPR measurement was calculated and compared with ICA and invasive FFR. Addition of stress-CTP with qualitative evaluation to rest-cCTA showed sensitivity, specificity, negative and positive predictive values, and accuracy at a vessel and patient level of 92{\%}, 92{\%}, 97{\%}, 82{\%}, 92{\%} and 98{\%}, 80{\%}, 97{\%}, 82{\%}, 89{\%}, respectively indicating a significant improvement of specificity, positive predictive value, and accuracy values vs. rest-cCTA in both models. Similarly, addition of stress-CTP with TPR evaluation to rest-cCTA showed sensitivity, specificity, negative and positive predictive values, and accuracy at a vessel and patient level of 84{\%}, 90{\%}, 93{\%}, 76{\%}, 88{\%} and 91{\%}, 71{\%}, 89{\%}, 75{\%}, 81{\%}, respectively indicating a significant improvement of specificity, positive predictive value values vs. rest-cCTA only in a vessel-based model and of positive predictive value in a patient-based model. When cCTA + stress-CTP with qualitative evaluation was compared with cCTA + stress-CTP with TPR estimation, no differences were found in terms of diagnostic performance. Conclusion The addition of stress-CTP with visual evaluation to cCTA imaging has similar diagnostic performance when compared with the quantitative analysis of myocardial perfusion based on TPR measurement. All rights reserved.",
keywords = "accuracy, computed tomography, computed tomography perfusion, coronary artery disease, myocardial perfusion, transmural perfusion ratio",
author = "Gianluca Pontone and Daniele Andreini and Guaricci, {Andrea I.} and Marco Guglielmo and Andrea Baggiano and Giuseppe Muscogiuri and Laura Fusini and Margherita Soldi and Fabio Fazzari and Claudio Berzovini and Annalisa Pasquini and Paolo Ciancarella and Saima Mushtaq and Edoardo Conte and Giuseppe Calligaris and {De Martini}, Stefano and Cristina Ferrari and Stefano Galli and Luca Grancini and Paolo Ravagnani and Giovanni Teruzzi and Daniela Trabattoni and Franco Fabbiocchi and Alessandro Lualdi and Piero Montorsi and Rabbat, {Mark G.} and Bartorelli, {Antonio L.} and Mauro Pepi",
year = "2018",
month = "11",
day = "1",
doi = "10.1093/ehjci/jey111",
language = "English",
volume = "19",
pages = "1244--1252",
journal = "European Heart Journal Cardiovascular Imaging",
issn = "2047-2404",
publisher = "Oxford University Press",
number = "11",

}

TY - JOUR

T1 - Quantitative vs. qualitative evaluation of static stress computed tomography perfusion to detect haemodynamically significant coronary artery disease

AU - Pontone, Gianluca

AU - Andreini, Daniele

AU - Guaricci, Andrea I.

AU - Guglielmo, Marco

AU - Baggiano, Andrea

AU - Muscogiuri, Giuseppe

AU - Fusini, Laura

AU - Soldi, Margherita

AU - Fazzari, Fabio

AU - Berzovini, Claudio

AU - Pasquini, Annalisa

AU - Ciancarella, Paolo

AU - Mushtaq, Saima

AU - Conte, Edoardo

AU - Calligaris, Giuseppe

AU - De Martini, Stefano

AU - Ferrari, Cristina

AU - Galli, Stefano

AU - Grancini, Luca

AU - Ravagnani, Paolo

AU - Teruzzi, Giovanni

AU - Trabattoni, Daniela

AU - Fabbiocchi, Franco

AU - Lualdi, Alessandro

AU - Montorsi, Piero

AU - Rabbat, Mark G.

AU - Bartorelli, Antonio L.

AU - Pepi, Mauro

PY - 2018/11/1

Y1 - 2018/11/1

N2 - Aims To compare the diagnostic accuracy of stress computed tomography myocardial perfusion (CTP) for the detection of significant coronary artery disease with visual approach vs. quantitative analysis with transmural perfusion ratio (TPR) in consecutive symptomatic patients scheduled for invasive coronary angiography (ICA) plus invasive fractional flow reserve (FFR). Methods and results Eighty-eight consecutive symptomatic patients underwent rest coronary computed tomography angiography (cCTA) followed by static stress-CTP. Diagnostic accuracy of cCTA + stress-CTP with visual evaluation and with TPR measurement was calculated and compared with ICA and invasive FFR. Addition of stress-CTP with qualitative evaluation to rest-cCTA showed sensitivity, specificity, negative and positive predictive values, and accuracy at a vessel and patient level of 92%, 92%, 97%, 82%, 92% and 98%, 80%, 97%, 82%, 89%, respectively indicating a significant improvement of specificity, positive predictive value, and accuracy values vs. rest-cCTA in both models. Similarly, addition of stress-CTP with TPR evaluation to rest-cCTA showed sensitivity, specificity, negative and positive predictive values, and accuracy at a vessel and patient level of 84%, 90%, 93%, 76%, 88% and 91%, 71%, 89%, 75%, 81%, respectively indicating a significant improvement of specificity, positive predictive value values vs. rest-cCTA only in a vessel-based model and of positive predictive value in a patient-based model. When cCTA + stress-CTP with qualitative evaluation was compared with cCTA + stress-CTP with TPR estimation, no differences were found in terms of diagnostic performance. Conclusion The addition of stress-CTP with visual evaluation to cCTA imaging has similar diagnostic performance when compared with the quantitative analysis of myocardial perfusion based on TPR measurement. All rights reserved.

AB - Aims To compare the diagnostic accuracy of stress computed tomography myocardial perfusion (CTP) for the detection of significant coronary artery disease with visual approach vs. quantitative analysis with transmural perfusion ratio (TPR) in consecutive symptomatic patients scheduled for invasive coronary angiography (ICA) plus invasive fractional flow reserve (FFR). Methods and results Eighty-eight consecutive symptomatic patients underwent rest coronary computed tomography angiography (cCTA) followed by static stress-CTP. Diagnostic accuracy of cCTA + stress-CTP with visual evaluation and with TPR measurement was calculated and compared with ICA and invasive FFR. Addition of stress-CTP with qualitative evaluation to rest-cCTA showed sensitivity, specificity, negative and positive predictive values, and accuracy at a vessel and patient level of 92%, 92%, 97%, 82%, 92% and 98%, 80%, 97%, 82%, 89%, respectively indicating a significant improvement of specificity, positive predictive value, and accuracy values vs. rest-cCTA in both models. Similarly, addition of stress-CTP with TPR evaluation to rest-cCTA showed sensitivity, specificity, negative and positive predictive values, and accuracy at a vessel and patient level of 84%, 90%, 93%, 76%, 88% and 91%, 71%, 89%, 75%, 81%, respectively indicating a significant improvement of specificity, positive predictive value values vs. rest-cCTA only in a vessel-based model and of positive predictive value in a patient-based model. When cCTA + stress-CTP with qualitative evaluation was compared with cCTA + stress-CTP with TPR estimation, no differences were found in terms of diagnostic performance. Conclusion The addition of stress-CTP with visual evaluation to cCTA imaging has similar diagnostic performance when compared with the quantitative analysis of myocardial perfusion based on TPR measurement. All rights reserved.

KW - accuracy

KW - computed tomography

KW - computed tomography perfusion

KW - coronary artery disease

KW - myocardial perfusion

KW - transmural perfusion ratio

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U2 - 10.1093/ehjci/jey111

DO - 10.1093/ehjci/jey111

M3 - Article

C2 - 30107557

AN - SCOPUS:85055162107

VL - 19

SP - 1244

EP - 1252

JO - European Heart Journal Cardiovascular Imaging

JF - European Heart Journal Cardiovascular Imaging

SN - 2047-2404

IS - 11

ER -