This Article Free upon publication Full Text Full Text (PDF) All Versions of this Article: 2/3/174    most recent CIRCIMAGING.108.813766v1 Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by George, R. T. Articles by Lima, J. A.C. Search for Related Content PubMed PubMed Citation Articles by George, R. T. Articles by Lima, J. A.C. Related Collections Cardiovascular imaging agents/Techniques CT and MRI Chronic ischemic heart disease Coronary circulation Related Article

Original Articles

Adenosine Stress 64- and 256-Row Detector Computed Tomography Angiography and Perfusion Imaging

A Pilot Study Evaluating the Transmural Extent of Perfusion Abnormalities to Predict Atherosclerosis Causing Myocardial Ischemia

Richard T. George, MD; Armin Arbab-Zadeh, MD; Julie M. Miller, MD; Kakuya Kitagawa, MD; Hyuk-Jae Chang, MD; David A. Bluemke, MD, PhD; Lewis Becker, MD; Omair Yousuf, MD; John Texter, PA-C; Albert C. Lardo, PhD and João A.C. Lima, MD

From the Department of Medicine, Division of Cardiology (R.T.G., A.A.-Z., J.M.M., K.K., H.-J.C., D.A.B., L.B., O.Y., J.T., A.C.L., J.A.C.L.), Department of Biomedical Engineering (A.C.L.), and Department of Radiology (D.A.B., J.A.C.L.), Johns Hopkins University School of Medicine, Baltimore, Md.

Correspondence to João A.C. Lima, MD, Johns Hopkins University, Department of Medicine, Division of Cardiology, 600 N Wolfe St, 524 Blalock Bldg, Baltimore, MD 21287. E-mail jlima{at}jhmi.edu

Received August 13, 2008; accepted March 17, 2009.

Background— Multidetector computed tomography coronary angiography (CTA) is a robust method for the noninvasive diagnosis of coronary artery disease. However, in its current form, CTA is limited in its prediction of myocardial ischemia. The purpose of this study was to test whether adenosine stress computed tomography myocardial perfusion imaging (CTP), when added to CTA, can predict perfusion abnormalities caused by obstructive atherosclerosis.

Methods and Results— Forty patients with a history of abnormal single-photon emission computed tomography myocardial perfusion imaging (SPECT-MPI) underwent adenosine stress 64-row (n=24) or 256-row (n=16) detector CTP and CTA. A subset of 27 patients had invasive angiography available for quantitative coronary angiography. CTA and quantitative coronary angiography were evaluated for stenoses 50%, and SPECT-MPI was evaluated for fixed and reversible perfusion deficits using a 17-segment model. CTP images were analyzed for the transmural differences in perfusion using the transmural perfusion ratio (subendocardial attenuation density/subepicardial attenuation density). The sensitivity, specificity, positive predictive value, and negative predictive value for the combination of CTA and CTP to detect obstructive atherosclerosis causing perfusion abnormalities using the combination of quantitative coronary angiography and SPECT as the gold standard was 86%, 92%, 92%, and 85% in the per-patient analysis and 79%, 91%, 75%, and 92% in the per vessel/territory analysis, respectively.

Conclusions— The combination of CTA and CTP can detect atherosclerosis causing perfusion abnormalities when compared with the combination of quantitative coronary angiography and SPECT.

Key Words: imaging • atherosclerosis • ischemia • perfusion • myocardium

---

 

CLINICAL PERSPECTIVE

Related Article

Anatomic and Functional Assessment of Coronary Artery Disease: Convergence of 2 Aims in a Single Setting

James K. Min and Daniel Berman
Circ Cardiovasc Imaging 2009 2: 163-165. [Extract] [Full Text] [PDF]

This article has been cited by other articles:

				R. J. Gibbons, P. A. Araoz, and E. E. Williamson The Year in Cardiac Imaging J. Am. Coll. Cardiol., February 2, 2010; 55(5): 483 - 495. [Full Text] [PDF]

				A. de Roos Myocardial Perfusion Imaging with Multidetector CT: Beyond Lumenography Radiology, February 1, 2010; 254(2): 321 - 323. [Full Text] [PDF]

				J. A. Rocha-Filho, R. Blankstein, L. D. Shturman, H. G. Bezerra, D. R. Okada, I. S. Rogers, B. Ghoshhajra, U. Hoffmann, G. Feuchtner, W. S. Mamuya, et al. Incremental Value of Adenosine-induced Stress Myocardial Perfusion Imaging with Dual-Source CT at Cardiac CT Angiography Radiology, February 1, 2010; 254(2): 410 - 419. [Abstract] [Full Text] [PDF]

				G. Bastarrika, Y. S. Lee, W. Huda, B. Ruzsics, P. Costello, and U. J. Schoepf CT of Coronary Artery Disease Radiology, November 1, 2009; 253(2): 317 - 338. [Abstract] [Full Text] [PDF]

				M. Salerno and G. A. Beller Noninvasive Assessment of Myocardial Perfusion Circ Cardiovasc Imaging, September 1, 2009; 2(5): 412 - 424. [Full Text] [PDF]

				J. K. Min and D. Berman Anatomic and Functional Assessment of Coronary Artery Disease: Convergence of 2 Aims in a Single Setting Circ Cardiovasc Imaging, May 1, 2009; 2(3): 163 - 165. [Full Text] [PDF]