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Myocardial perfusion in patients with suspected coronary artery disease: comparison between 320-MDCT and rubidium-82 PET

  • Cardiac
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Abstract

Objectives

Despite advances in non-invasive myocardial perfusion imaging (MPI) evaluation, computed tomography (CT) multiphase MPI protocols have not yet been compared with the highly accurate rubidium-82 positron emission tomography (82RbPET) MPI. Thus, this study aimed to evaluate agreement between 82RbPET and 320-detector row CT (320-CT) MPI using a multiphase protocol in suspected CAD patients.

Methods

Forty-four patients referred for MPI evaluation were prospectively enrolled and underwent dipyridamole stress 82RbPET and multiphase 320-CT MPI (five consecutive volumetric acquisitions during stress). Statistical analyses were performed using the R software.

Results

There was high agreement for recognizing summed stress scores ≥ 4 (kappa 0.77, 95% CI 0.55–0.98, p < 0.001) and moderate for detecting SDS ≥ 2 (kappa 0.51, 95% CI 0.23–0.80, p < 0.001). In a per segment analysis, agreement was high for the presence of perfusion defects during stress and rest (kappa 0.75 and 0.82, respectively) and was moderate for impairment severity (kappa 0.58 and 0.65, respectively). The 320-CT protocol was safe, with low radiation burden (9.3 ± 2.4 mSv).

Conclusions

There was a significant agreement between dipyridamole stress 320-CT MPI and 82RbPET MPI in the evaluation of suspected CAD patients of intermediate risk. The multiphase 320-CT MPI protocol was feasible, diagnostic and with relatively low radiation exposure.

Key Points

• Rubidium-82 PET and 320-MDCT can perform MPI studies for CAD investigation.

• There is high agreement between rubidium-82 PET and 320-MDCT for MPI assessment.

• Multiphase CT perfusion protocols are feasible and with low radiation.

• Multiphase CT perfusion protocols can identify image artefacts.

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Abbreviations

%MI:

Percentage myocardium ischaemia

320-CT:

320-detector row MDCT

CAD:

Coronary artery disease

CS:

Coronary calcium score

CT:

Computed tomography

CTA:

Coronary computed tomography angiography

CTP:

Computed tomography myocardial perfusion

Cx:

Circumflex coronary artery

ECG:

Electrocardiogram

ERD:

Effective radiation dose

FFR:

Fractional flow reserve

ICA:

Invasive coronary angiography

LAD:

Left anterior descending coronary artery

MDCT:

Multi-detector row computed tomography

MPI:

Myocardial perfusion imaging

82RbPET:

Rubidium-82 positron emission tomography

RCA:

Right coronary artery

SDS:

Summed difference score

SPECT:

Single photon emission computed tomography

SRS:

Summed rest score

SSS:

Summed stress score

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Funding

This study has received funding by São Paulo Research Foundation (Fundação de Amparo à Pesquisa do Estado de São Paulo - FAPESP) - research grant number 2010/ 51100-7.

Author information

Authors and Affiliations

  1. Computed Tomography Department, Heart Institute, InCor, University of Sao Paulo Medical School, Sao Paulo, Brazil

    Roberto Nery Dantas Jr, Antonildes Nascimento Assuncao Jr, Ismar Aguiar Marques, Mateus Guimaraes Fahel, Cesar Higa Nomura, Luiz Francisco Rodrigues Avila & Jose Rodrigues Parga

  2. Radiology Institute, InRad, University of Sao Paulo Medical School, Sao Paulo, Brazil

    Roberto Nery Dantas Jr, Cesar Higa Nomura, Luiz Francisco Rodrigues Avila & Jose Rodrigues Parga

  3. Cardiovascular Magnetic Resonance and Computed Tomography Sector, Heart Institute, InCor, University of Sao Paulo Medical School, Av. Dr. Enéas de Carvalho Aguiar, 44, Andar AB, Cerqueira César, São Paulo, SP, 05403-000, Brazil

    Roberto Nery Dantas Jr

  4. Department of Nuclear Medicine and Molecular Imaging, Heart Institute, InCor, University of Sao Paulo Medical School, Sao Paulo, Brazil

    Maria Clementina Pinto Giorgi, Jose Soares Jr & Jose Claudio Meneghetti

Authors
  1. Roberto Nery Dantas Jr
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  2. Antonildes Nascimento Assuncao Jr
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  7. Maria Clementina Pinto Giorgi
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Corresponding author

Correspondence to Roberto Nery Dantas Jr.

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Guarantor

The scientific guarantor of this publication is Jose Rodrigues Parga.

Conflict of interest

The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Statistics and biometry

Marcio Augusto Diniz kindly provided statistical advice for this manuscript.

One of the authors has significant statistical expertise (Antonildes N. Assuncao).

Informed consent

Written informed consent was obtained from all subjects (patients) in this study.

Ethical approval

Institutional review board approval was obtained.

Methodology

• Prospective

• Diagnostic or prognostic study

• Performed at one institution

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Dantas, R.N., Assuncao, A.N., Marques, I.A. et al. Myocardial perfusion in patients with suspected coronary artery disease: comparison between 320-MDCT and rubidium-82 PET. Eur Radiol 28, 2665–2674 (2018). https://doi.org/10.1007/s00330-017-5257-2

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  • DOI: https://doi.org/10.1007/s00330-017-5257-2

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