Adenosine stress rubidium-82 PET/computed tomography in patients with known and suspected coronary artery disease

BACKGROUND: Integrated positron emission tomography/computed tomography (PET/CT) is increasingly being utilized for myocardial perfusion imaging (MPI). However, there is a potential for increased imaging artifact compared with standard PET due to the different temporal resolution of PET and CT. We reviewed the diagnostic accuracy of adenosine stress Rb myocardial perfusion PET/CT to detect obstructive coronary artery disease (CAD) on invasive angiography at our institution. METHODS AND RESULTS: Seventy-five patients were included, 23 (13 men, mean age 55.8+/-11.8 years) with low likelihood of CAD and 52 (28 men, mean age 67.1+/-11.4 years) with intermediate to high pretest probability of disease. Coronary angiography was performed only in the latter 52 patients on average within 17 days of the MPI study. The test characteristics of PET/CT MPI were assessed using a threshold of >or=50 and >or=70% stenosis in one or more major coronary artery on invasive angiography. Dedicated software was used for registration, processing, and interpretation. Consensus interpretation of the tomographic PET slices using a 4-point scale (1=definitely normal, 2=probably normal, 3=probably abnormal, 4=definitely abnormal) was done by two readers blinded to clinical information. RESULTS: All MPI studies in the 23 low likelihood patients were normal. In the remaining 52 patients using a stenosis severity>or=50%, global sensitivity and specificity, negative and positive predictive value for detection of CAD were 86, 100, 57, and 100%. Using a stenosis severity>or=70%, these values changed to 90, 83, 71, and 87%. CONCLUSION: Adenosine stress Rb MPI using PET/CT with manual registration demonstrates diagnostic accuracy comparable with that of traditional PET MPI.