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Hybrid CT angiography and quantitative 15O-water PET for assessment of coronary artery disease: comparison with quantitative coronary angiography

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Abstract

Purpose

CT angiography (CTA) can rule out significant stenoses with a very high reliability, whereas its ability to confirm significant stenoses is suboptimal. In contrast, measurements of myocardial blood flow (MBF) provide information on the haemodynamic consequences of stenoses. Therefore, a combination of the two might improve diagnostic accuracy. We conducted a head-to-head comparison of CTA, measurement of MBF by 15O-water PET, and hybrid PET/CTA for the detection of significant coronary artery stenoses.

Methods

The study group comprised 44 outpatients scheduled for invasive coronary angiography (ICA) with an intermediate pretest likelihood of coronary artery disease. The patients underwent 64-slice CTA and baseline and hyperaemic PET before ICA with quantitative coronary angiography analysis.

Results

On a per-patient basis, the negative predictive values (NPV; 95 % confidence intervals in parentheses) were 88 % (64 – 97 %) for CTA, 90 % (71 – 97%) for PET and 92 % (74 – 98%) for PET/CTA, and the positive predictive values (PPV) were 71 % (53 – 85%) for CTA, 87 % (68 – 95%) for PET and 100 % (84 – 100%) for PET/CTA. Similarly, on a per-vessel basis the NPVs (which were generally high) were 97 % (94 – 100%) for CTA, 95 % (90 – 99%) for PET and 97 % (95 – 100%) for PET/CTA, and the PPVs (which were lower, but higher with PET/CTA) were 53 % (39 – 66%) for CTA, 53 % (40 – 66%) for PET and 85 % (73 – 97%) for PET/CTA. In six patients, CTA analysis was hampered by the presence of severe calcifications. However, with the addition of the PET data, all six patients were correctly categorized.

Conclusion

Cardiac quantitative hybrid PET/CTA imaging has better diagnostic accuracy than CTA alone and PET alone. CTA has a suboptimal PPV, suggesting that hybrid PET/CTA imaging should be used to assess the significance of coronary stenoses diagnosed by CTA.

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Authors and Affiliations

  1. Department of Nuclear Medicine, OUH, Odense University Hospital, Sdr. Boulevard 29, 5000, Odense C, Denmark

    Anders Thomassen, Henrik Petersen, Allan Johansen, Oke Gerke, Poul-Erik Braad, Mette M. Høilund-Carlsen & Poul F. Høilund-Carlsen

  2. Department of Cardiology, OUH, Odense University Hospital, Odense, Denmark

    Axel C. P. Diederichsen, Hans Mickley, Lisette O. Jensen & Per Thayssen

  3. Centre of Health Economics Research, University of Southern Denmark, Odense, Denmark

    Oke Gerke

  4. Clinical Epidemiology, Institute of Medical Biometry and Medical Informatics, University Medical Center Freiburg, Freiburg, Germany

    Werner Vach

  5. Turku University Hospital and University of Turku, Turku, Finland

    Juhani Knuuti

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  1. Anders Thomassen
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Correspondence to Anders Thomassen.

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Thomassen, A., Petersen, H., Diederichsen, A.C.P. et al. Hybrid CT angiography and quantitative 15O-water PET for assessment of coronary artery disease: comparison with quantitative coronary angiography. Eur J Nucl Med Mol Imaging 40, 1894–1904 (2013). https://doi.org/10.1007/s00259-013-2519-3

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  • DOI: https://doi.org/10.1007/s00259-013-2519-3

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