Key result
Integrated SPECT/CTCA boosts specificity to 95% vs CTCA alone for hemodynamically significant CAD.
Why the study?
Does integrated SPECT/CTCA improve the diagnostic accuracy for detecting hemodynamically significant coronary lesions compared to CTCA alone in patients with angina pectoris?
Cross-Sectional (n=56)
Does integrated SPECT/CTCA improve the diagnostic accuracy for detecting hemodynamically significant coronary lesions compared to CTCA alone in patients with angina pectoris?
Hybrid SPECT/CTCA imaging significantly improves specificity and positive predictive value for detecting hemodynamically significant coronary lesions compared to CTCA alone.
OBJECTIVES: The purpose of this study was to assess the physiologic significance of coronary artery lesions with an integrated single-photon emission computed tomography (SPECT) and computed tomography coronary angiography (CTCA) device. BACKGROUND: Myocardial perfusion imaging (MPI) with SPECT is of value for assessing the physiologic significance of coronary lesions. Computed tomography coronary angiography is a new technique to noninvasively detect coronary stenosis, with high sensitivity and negative predictive value (NPV) but lower specificity and positive predictive value (PPV). The experimental SPECT/CTCA hybrid imaging device (Infinia gamma camera and LightSpeed16 CT, General Electric, Milwaukee, Wisconsin) enables concurrent assessment of coronary anatomy and myocardial perfusion. METHODS: Fifty-six patients with angina pectoris underwent single-session SPECT-MPI and CTCA with the hybrid device and coronary angiography (CA) within 4 weeks. The ability of fused SPECT/CTCA images to diagnose physiologically significant lesions showing >50% stenosis and reversible perfusion defects in the same territory was determined and compared with CTCA stand-alone. RESULTS: Of a total of 224 coronary segments in 56 patients, 12 patients and 54 segments (23%) were excluded from further analysis of CTCA. Overall, 170 coronary segments were evaluated. The sensitivity, specificity, PPV, and NPV of CTCA were 96%, 63%, 31%, and 99%, respectively, as compared with 96%, 95%, 77%, and 99%, respectively, for SPECT/CTCA. CONCLUSIONS: Hybrid SPECT/CTCA imaging results in improved specificity and PPV to detect hemodynamically significant coronary lesions in patients with chest pain. Single-photon emission computed tomography/CTCA might play a potentially important role in the noninvasive diagnosis of coronary artery disease and introduce an objective decision-making tool for assessing the need for interventions in each occluded vessel.
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Rispler et al. (2007) conducted a cross-sectional in Angina pectoris (n=56). Integrated single-photon emission computed tomography and computed tomography coronary angiography (SPECT/CTCA) vs. CTCA stand-alone was evaluated on Diagnosis of physiologically significant lesions showing >50% stenosis and reversible perfusion defects in the same territory. Integrated SPECT/CTCA improved specificity (95% vs 63%) and positive predictive value (77% vs 31%) for detecting hemodynamically significant coronary lesions compared to CTCA alone.
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