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Comparative Study
. 2007 Aug;23(10):801-7.
doi: 10.1016/s0828-282x(07)70831-0.

Comparison of computed tomographic angiography versus rubidium-82 positron emission tomography for the detection of patients with anatomical coronary artery disease

Benjamin J W Chow  1 , Carole Dennie, Udo Hoffmann, Derek So, Robert A de Kemp, Terrence D Ruddy, Rob S Beanlands
Affiliations
Comparative Study

Comparison of computed tomographic angiography versus rubidium-82 positron emission tomography for the detection of patients with anatomical coronary artery disease

Benjamin J W Chow et al. Can J Cardiol. 2007 Aug.

Abstract
in English, French

Background: The present study compared computed tomographic coronary angiography (CTA) and positron emission tomography (PET) for the detection of significant anatomical coronary artery stenosis as defined by conventional invasive coronary angiography (CICA).

Methods: The study protocol was approved by the local ethics board, and informed consent was obtained from all patients. Of the 26 patients (mean age 57+/-9 years, 18 men) who prospectively underwent CTA and rubidium-82 PET before CICA, 24 patients had a history of chest pain. Images were interpreted by expert readers and assessed for the presence of anatomically significant coronary stenosis (50% luminal diameter stenosis or greater) or myocardial perfusion defects. Diagnostic test characteristics were analyzed using patient-based, territory-based, vessel-based and segment-based analyses.

Results: In the 24 patients referred for chest pain, CTA had similar sensitivity to PET, but was more specific (sensitivity 95% [95% CI 72% to 100%] versus 95% [95% CI 72% to 100%], respectively; specificity 100% [95% CI 46% to 100%] versus 60% [95% CI 17% to 93%], respectively) in the detection of patients with anatomical coronary artery stenosis of 50% or greater. On a per-segment basis of all 26 patients, CTA had a sensitivity, specificity, positive predictive value and negative predictive value of 72%, 99%, 91% and 95%, respectively, in all coronary segments.

Conclusions: Coronary CTA has a similar sensitivity and specificity to rubidium-82 PET for the identification of patients with significant anatomical coronary artery disease.

CONTEXTE :: La présente étude visait à comparer la coronarographie par tomodensitométrie (CTDM) avec la tomographie par émission de positrons (TEP) en vue de la détection de sténoses anatomiques coronariennes importantes, confirmées par la coronarographie classique effractive (CCE).

MÉTHODE :: Le protocole de l’étude a reçu l’approbation du comité local d’éthique, et tous les sujets ont signé un consentement éclairé. Sur 26 patients (âge moyen : 57±9 ans; hommes : 18) qui ont subi, de façon prospective, la CTDM et la TEP au rubidium 82 avant la CCE, 24 avaient des antécédents de douleur thoracique. Les images ont été interprétées par des spécialistes, qui les ont examinées à la recherche de sténoses anatomiques coronariennes importantes, c’est-à-dire égales ou supérieures à 50 % de la lumière des vaisseaux, ou d’images lacunaires d’irrigation. Il y a eu analyse des caractéristiques des examens de diagnostic en fonction des patients, des territoires, des vaisseaux et des segments.

RÉSULTATS :: Chez les 24 patients dirigés en radiologie pour des douleurs thoraciques, la CTDM avait une sensibilité comparable à celle de la TEP mais une spécificité plus grande que celle-ci (sensibilité : 95 % [IC : 72 % à 100 %] contre 95 % [IC : 72 % à 100 %], respectivement; spécificité : 100 % [IC : 46 % à 100 %] contre 60 % [IC : 17 % à 93 %], respectivement) en ce qui concerne la détection des sténoses anatomiques coronariennes, égales ou supérieures à 50 %. Quant à l’analyse par segment chez les 26 sujets, la CTDM avait une sensibilité, une spécificité, une valeur prédictive positive et une valeur prédictive négative de 72 %, 99 %, 91 % et 95 % respectivement, et ce, dans tous les segments coronariens.

CONCLUSION :: La CTDM a une sensibilité et une spécificité comparables à celles de la TEP au rubidium 82 pour la détection des sténoses anatomiques coronariennes importantes.

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Figures

Figure 1)
Figure 1)
Positron emission tomography magnetic perfusion imaging, computed tomographic angiography and conventional invasive coronary angiography of a 73-year-old man with chest pain. A Positron emission tomography myocardial perfusion imaging: post-stress, a moderate (blue) reduction in rubidium-82 (Rb-82) uptake is present in the basal and mid-inferior wall, with normalization at rest. B Curved multiplanar reformation computed tomography and conventional invasive coronary angiography images demonstrating an occluded proximal right coronary artery (arrow). C Significant stenosis of the proximal left anterior descending coronary artery (large arrow) and the first marginal artery (small arrow). HLA Horizontal long axis; SA Short axis; VLA Vertical long axis
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