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Observational Study
. 2019 Dec;113(6):1092-1101.
doi: 10.5935/abc.20190201.

Myocardial Perfusion by Coronary Computed Tomography in the Evaluation of Myocardial Ischemia: Simultaneous Stress Protocol with SPECT

[Article in English, Portuguese]
Wilter Dos Santos Ker  1   2 , Daniel Gama das Neves  2 , Tiago Augusto Magalhães  3 , Alair Augusto Sarmet M D Dos Santos  1 , Claudio Tinoco Mesquita  1 , Marcelo Souto Nacif  1   2   3
Affiliations
Observational Study

Myocardial Perfusion by Coronary Computed Tomography in the Evaluation of Myocardial Ischemia: Simultaneous Stress Protocol with SPECT

[Article in English, Portuguese]
Wilter Dos Santos Ker et al. Arq Bras Cardiol. 2019 Dec.

Abstract

Background: Functional assessment to rule out myocardial ischemia using coronary computed tomography angiography (CCTA) is extremely important and data on the Brazilian population are still limited.

Objective: To assess the diagnostic performance of myocardial perfusion by CCTA in the detection of severe obstructive coronary artery disease (CAD) compared with single-photon emission computerized tomography (SPECT). To analyze the importance of anatomical knowledge to understand the presence of myocardial perfusion defects on SPECT imaging that is not identified on computed tomography (CT) scan.

Method: A total of 35 patients were evaluated by a simultaneous pharmacologic stress protocol. Fisher's exact test was used to compare proportions. The patients were grouped according to the presence or absence of significant CAD. The area under the ROC curve was used to identify the diagnostic performance of CCTA and SPECT in perfusion assessment. P < 0.05 values were considered statistically significant.

Results: For detection of obstructive CAD, CT myocardial perfusion analysis yielded an area under the ROC curve of 0.84 [a 95% confidence interval (CI95%): 0.67-0.94, p < 0.001]. SPECT myocardial perfusion imaging, on the other hand, showed an AUC of 0.58 (95% CI 0.40 - 0.74, p < 0.001). In this study, false-positive results with SPECT are described.

Conclusion: Myocardial perfusion analysis by CTA displays satisfactory results compared to SPECT in the detection of obstructive CAD. CCTA can rule out false-positive results of SPECT.

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Conflict of interest statement

Potential Conflict of Interest

No potential conflict of interest relevant to this article was reported.

Figures

Figure 1
Figure 1
The selection of patients for this observational study included 38 patients from our institution [Antonio Pedro University Hospital – Federal Fluminense University (HUAP-UFF)], recruited in the Nuclear Medicine Service. CTA: computed angiotomography; CAD: coronary artery disease; SPECT: Single-photon emission computed tomography; ICF: Informed consent form.
Figure 2
Figure 2
Comparison between myocardial perfusion images with stress perfusion defects on computed tomography (CT) and on single-photon emission computed tomography (SPECT). Concordant example of a same patient with significant obstructive anterior descending (LAD) coronary artery disease.
Figure 3
Figure 3
Comparison between myocardial perfusion methods sensitivity and specificity for detecting obstructive coronary artery disease. SPECT: Single-photon emission computed tomography; CT: computed tomography.
Figure 4
Figure 4
Analysis of the area under the ROC curve showing diagnostic perfusion performance of CT [0.84 (CI 95%: 0.67-0.94, p < 0.001)] and of scintigraphy (SPECT) [0.58 (CI 95%: 0.40-0.74, p < 0.001)], in this study.
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