Enhanced diagnostic utility achieved by myocardial blood analysis: A meta-analysis of noninvasive cardiac imaging in the detection of functional coronary artery disease

Abstract Aim The aim of this study is to determine the diagnostic utility of 6 cardiac imaging modalities using fractional flow reserve (FFR) as the reference standard. Methods Studies reporting diagnostic performance of computed tomographic perfusion imaging (CTP), fractional flow reserve derived from computed tomography (FFR CT ), cardiac magnetic resonance (CMR), positron emission tomography (PET), single-photon emission computed tomography (SPECT) and dobutamine stress echocardiography (DSE) for diagnosis of ischemia-causing lesions were included. Results On vessel-based and patient-based analyses, CMR, PET, CTP and FFR CT exhibited comparable sensitivity (per-vessel: 87% vs. 86% vs. 89% vs. 86%; per-patient: 88% vs. 90% vs. 88% vs. 90%, P >0.05) and specificity (per-vessel: 89% vs. 88% vs. 89% vs. 83%; per-patient: 84% vs. 84% vs. 87% vs. 75%, P >0.05); whereas SPECT yielded significantly lower sensitivity (per-vessel: 72%; per-patient: 78%, P P P P =0.048) but lower specificity (77% vs. 93%, P =0.02) than that of perfusion defect (PD). Moreover, MBF derived by CMR had a lower specificity than that of PD (60% vs. 93%, P =0.02), while coronary flow reserve (CRF) derived by PET had a lower specificity than that of MBF (81% vs. 89%, P =0.005). Conclusion CMR, PET, CTP and FFR CT expressed similar and high accuracy in detecting functional CAD, whereas different analysis methods for each imaging modality may vary their diagnostic utility.