Comparison of Single Imaging and Fusion Imaging Technique for Assessing Myocardial Perfusion in Patients of Type 2 Diabetes Mellitus With Coronary Artery Lesions
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Objective:To compare the effect of single myocardial perfusion imaging(MPI) and MPI combined with coronary CT angiography(CCTA) on coronary artery lesion diagnosis in patients of type 2 diabetes mellitus(DM) with coronary artery lesions. Methods:A total of 85 diabetic patients with coronary artery disease(CAD) or suspected CAD were examined by adenosine stress/rest MPI and coronary angiography(CAG) within one month,38 of them underwent CCTA with the same SPECT/CT facility.MPI was evaluated by semi quantitative visual interpretation using a 17-segment model.According to CAG and CCTA stan-dard,the coronary condition was defined as normal,mild,intermediate and severe lesions.CAG and CAG/ MPI combination were used to evaluate the effect of coronary lesion diagnosis for MPI and MPI/CCTA fusion imaging.Results:In 85 patients,MPI presented normal/abnormal was 22/63.MPI diagnostic sensitivity,specificity,accuracy,positive and negative prediction rate for coronary lesions were 80.19%,88.59%,85.10%,83.33% and 86.27% respectively;it showed 20(24%) mild lesion cases,12(14%) intermediate lesion cases and 31(36%) severe lesion cases.For 38 patients who underwent CCTA,the diagnostic sensitivity,specificity,accuracy,positive and negative prediction rate by MPI vs.MPI/CCTA were 74.55% vs.96.97%,81.36% vs.91.67%,78.07% vs.94.74%,78.85% vs.94.12% and 77.42% vs.95.65% respectively.MPI/CCTA fusion imaging presented normal 40.35%(46 segment /114 branch),intermediate or more stenosis 59.65%(68 segment /114 branch).Conclusion:MPI/CCTA fusion imaging has been superior to MPI alone for early CAD diagnosis in DM patients with coronary artery lesions.Cite
Objective To study and compare the diagnostic value in severe coronary artery disease (CAD) of 99 Tc m methoxyisobutylisonitrile (MIBI) electrocardiogram (ECG) gated early post exercise myocardial perfusion imaging (G MPI) with that of non ECG gated myocardial perfusion imaging (NG MPI). Methods Two hundred and fifteen suspected CAD patients had undergone G MPI and coronary artery angiography (CAG) within one month were enrolled and distributed into three vessel and non three vessel CAD groups according to CAG results (≥70%); the diagnostic values in severe CAD of G MPI and NG MPI were gained and compared to determine which one of the two protocols would be superior in identification of severe three vessel CAD. Results When the ≥70% diameter stenosis CAG was the diagnostic standard of severe CAD, the sensitivity of G MPI and NG MPI in the diagnosis of severe CAD were 95.3% (143/150) and 90.7% (136/150, χ 2=2.509, P =0 113), but when the comparison specifically pinpointed to severe three vessel CAD, there was significant difference between G MPI [100%(51/51)] and NG MPI [92.2% (47/51), χ 2=4.163, P =0.041]. Diagnostic specificity of G MPI was 80.0% and that of NG MPI was 72.3% ( χ 2=1.059, P =0.303). Conclusions The incremental diagnostic sensitivity of G MPI adding to the NG MPI in the diagnosis of severe CAD was mainly from the three vessel subgroup patients.Exercise stress G MPI has better diagnostic value in severe three vessel CAD patients than NG MPI.
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Objective To explore the value of adenosine(ADE) stress gated myocardial perfusion imaging(G-MPI) and dual-source CT coronary angiography(DSCTCA) in diagnosis of coronary artery disease(CAD).Methods Fifty-three patients with low,medium and high probability of CAD underwent resting(REST),ADE stress G-MPI and DSCTCA,then they underwent CAG within 4 weeks.MPI results were analyzed using the American Heart Association 17 segment 5-point scale(0—4 points) visual semi-quantitative method,and the resting and stress rating of the difference 1 were identified as reversible defect.Coronary stenosis were determined using international common law of DSCTCA visual diameter and were divided into normal and stenosis 50% or ≥50%.Taking CAG results as gold standards and stenosis ≥50% defined as CAD,diagnostic value of MPI and DSCTCA was compared.Results According to CAG results,the sensitivity,specificity and accuracy of G-MPI and DSCTCA in diagnosis of CAD was 94.44%(34/36),52.94%(9/17),81.13%(43/53) and 88.89%(32/36),88.24%(15/17),88.68%(47/53),respectively(χ2=9.28,P=0.005).Conclusion G-MPI and DSCTCA both have high value in diagnosis of CAD,combination of these two methods can improve the diagnostic utility of CAD through obtaining both functional and anatomical information.
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13N-ammonia positron emission tomography-computed tomography (PET-CT) is being increasingly used as a non-invasive imaging modality for evaluating patients with known or suspected coronary artery disease (CAD), but information about the diagnostic accuracy of PET-MPI is sparse. Objectives: Our objective was to determine the accuracy of 13N-ammonia PET-CT myocardial perfusion imaging (MPI) for detecting CAD.We retrospectively evaluated 383 patients with suspected CAD who underwent rest-stress 13N- ammonia PET-CT MPI. Invasive coronary angiography (ICA) was performed within 60 days for all patients with abnormal PET-MPI findings and for selected patients with normal PET-MPI findings.The mean age of the patients was 64±11 years, and the mean body mass index was 32±7 kg/m2. Stress perfusion defects were identified in 147 (34%) out of a total of 383 patients. ICA was performed in 213 patients (145 patients with abnormal PET and 68 patients with normal PET). The sensitivity of PET-MPI for detection of obstructive CAD based on ≥50% stenosis was 90%; specificity, 90%; positive predictive value, 96%; negative predictive value, 76%; and diagnostic accuracy, 80%.PET-MPI with 13N-ammonia affords high sensitivity and overall accuracy for detecting CAD. The addition of coronary artery calcium score (CACS) can improve CAD risk stratification.
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Objective To investigate myocardial perfusion imaging(MPI) combined with coronary CT angiography(CTA) in diagnosis of culprit coronary artery.Methods From 2012 Februarv-2013 December,hospitalized patients with coronary heart disease(33 cases) were enrolled,male of 25 cases,female ol 8 cases,age from 35 to 75 years old(55.2 ±20.2),they were underwent N-NH,PET adenosine/ resting MPI and coronary artery CTA examination,within 1 months of coronary arteriography(CAG),respectively.The MPI,CTA and CAG were analyzed;using CAG as golden standard,the diagnostic value of coronary CTA,MPI and MPI combined coronary artery CTA were analyzed.Results(1) The sensitivity of CTA in diagnosis of coronary heart disease was 90.0%(36/40),the specificity was 95.0%(302/318),the predictive value was 69.2%(36/52),the predictive value was 98.7%(302/306).(2) The sensitivity of MPI in diagnosis of coronary heart disease was 90.9%(20/22),the specificity was 90.9%(10/11),the predictive value was95.2%(20/21),the predictive value was 83.3%(10/12).(3) The sensitivity of MPI combined with CTA in diagnosis ol coronary heart disease was 95.5%(20/21),the specificity was 100%(11/11),the predictive value was100%(21/21),the predictive value was 91.7%(11/12).Conclusion MPI combined with coronary CTA can decrease the false positive and false negative results caused by MPI or CTA alone,provides higher accuracy for the diagnosis and treatment of coronary heart disease,especially to improve the detection rate of culprit vessel.
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Coronary arteries
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Objective
To evaluate the diagnostic value of one-stop cardiac CT (stress dynamic CT-MPI combining with CTA) in CAD.
Methods
Thirty patients underwent CCTA combined with stress dynamic CT-MPI and stress SPECT-MPI including 16 patients underwent ICA were retrospectively enrolled. All procedures were performed within 2 weeks without related treatment. CT-MPI and SPECT-MPI were evaluated visually and MBF was quantified according to dynamic CT-MPI which was compared through paired t test. The diagnostic value of CT-MPI for myocardial ischemia was evaluated with SPECT-MPI as the reference standard. The consistency between the two techniques was determined by Kappa test. With SPECT combined with ICA as the reference standard, we evaluated the value of CT-MPI and its combination with CCTA in the diagnosis of CAD with hemodynamic stenosis.
Results
On stress CT-MPI, 19 of 30 patients and 52 segments were evaluated with myocardial perfusion defects. There was a significant difference in MBF values between normal[(117.61±29.82)ml·100 ml-1·min-1] and hypoperfused [(80.60±22.15)ml·100 ml-1·min-1] segments (t=15.764,P<0.001). With SPECT as reference standard, the sensitivity, specificity were 94.12% (32/34), 95.80% (456/476) on the vessel basis. The Kappa value of the two examinations was 0.772(P<0.001). As for the 16 patients who also underwent ICA, 15 patients with 22 vessel-areas had hemodynamic stenosis on CT-MPI. Compared with SPECT combined with ICA, the sensitivity, specificity for detecting hemodynamic stenosis were 92.31% (12/13), 71.43% (25/35) for CT-MPI; 100% (13/13), 51.43% (18/35) for CTA and 92.31% (12/13), 82.86% (29/35) for CT-MPI combined with CTA, respectively. Moderate correlation was observed between the combination of CT-MPI and CCTA and reference standard (r=0.690, P<0.001).
Conclusion
Stress dynamic CT-MPI can detect myocardial perfusion defects and hemodynamic changes and improves the diagnostic ability of functional stenosis of CAD combined with CTA, which can finally achieve the one-stop mode of cardiac CT in CAD.
Key words:
Myocardial ischemia; Tomography, X-ray computed; Myocardial perfusion imaging; Coronary stenosis
Kappa
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Objective:To evaluate and compare the diagnostic efficacy of coronary computed tomography angiography(CCTA) versus treadmill exercise test(TET) for diagnosing coronary artery disease(CAD).Methods:The results of coronary angiography(CAG) were set as the gold standard for diagnosing CAD(≥50% luminal stenosis).All 75 patients with suspected CAD who underwent CAG,CCTA and TET were retrospectively analyzed.The findings of TET and CCTA were compared with that of CAG.Results:The sensitivity,specificity,positive predictive value,negative predictive value and accuracy of TET and CCTA in diagnosis of CAD were 45.2% and 90.5%,69.7% and 93.9%,65.5% and 95.0%,50.0% and 88.6%,56.0% and 92.0%,respectively(P0.01).In vessel level,the diagnostic accuracy of CCTA for evaluating the right coronary artery,left main artery,left anterior descending artery,left circumflex artery were 86.7%,100.0%,88.0% and 76.0%,respectively.The results of TET in the patients with CAD were positively related to the number of the diseased vessels(r=0.440,P=0.004).The numbers of involved vessels with ≥75% stenosis were found having significant difference in positive and negative groups of TET(P=0.016).Conclusion:The diagnostic accuracy of CCTA for diagnosing CAD had significantly higher accuracy and lower false positive and negative diagnosis in comparison with treadmill exercise test.CCTA plays important role in symptomatic patients who were suspected for CAD.
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Positive predicative value
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Objective To evaluate the diagnostic accuracy of a combined non-invasive assessment of coronary artery disease with coronary computed tomography angiography(CCTA) and myocardial perfusion imaging(MPI) for the detection of flow-limiting coronary stenoses and its potential as a gatekeeper for invasive examination and treatment.Methods A total of 78 patients with known or suspected coronary artery disease(CAD) were examined by adenosine stress/rest MPI and coronary angiography(CAG) within one month,at the same time these patients underwent CCTA with the same SPECT/CT facility.MPI was evaluated by semi-quantitative visual interpretation using a 15-segment model.According to CAG and CCTA standard,a significant stenosis was defined as a diameter reduction of ≥50%.Detection of flow-limiting stenoses(justifying revascularization) by the combination of CCTA and MPI(MPI/CCTA) was compared with the combination of CAG plus MPI(MPI/CAG),which served as standard of reference.Results In 78 patients,MPI image revealed 66 reversible,6 fixed and 6 normal.The distribution of the perfusion defects among the different coronary artery territories was as follows: reversible perfusion defects: left anterior descending artery(LAD)(n=55),left circumflex artery(LCX)(n=14),right coronary artery(RCA)(n=11);fixed perfusion defects: LAD(n=4);RCA(n=3).CCTA image analysis revealed a stenosis in 74/234 coronary arteries of 56/78 patients.MPI/CCTA image analysis revealed a stenosis in 56/78 patients.The diagnostic sensitivity,specificity,accuracy,positive and negative predictive values by MPI/CCTA vs MPI/CAG for the detection of flow-limiting coronary stenosis on patient-based and vessel-based analysis were 94.33%,72.00%,87.18%,87.71%,85.71% and 88.71%,92.44%,91.45%,80.89%,95.78%.All of revascularization procedures(46,100%) were associated with ischemia on MPI,but more than a third(25/67,37%)of revascularized vessels were not associated with ischemia on MPI.Conclusion The combined non-invasive approach MPI/CCTA has an excellent acuracy to detect flow-limiting coronary stenoses compared with MPI/CAG.Its advantage lies in the non-invasive evaluation of coronary anatomy and function,and its use as a gatekeeper appears to make a substantial part of revascularization procedures redundant.
Fractional Flow Reserve
Coronary arteries
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Circumflex
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Myocardial perfusion imaging (MPI) is an accurate noninvasive test for patients with suspected obstructive coronary artery disease (CAD) and coronary artery calcium (CAC) score is known to be a powerful predictor of cardiovascular events. Collection of CAC scores simultaneously with MPI is unexplored.We aimed to investigate whether automatically derived CAC scores during myocardial perfusion imaging would further improve the diagnostic accuracy of MPI to detect obstructive CAD.We analyzed 150 consecutive patients without a history of coronary revascularization with suspected obstructive CAD who were referred for 82Rb PET/CT and available coronary angiographic data. Myocardial perfusion was evaluated both semi quantitatively as well as quantitatively according to the European guidelines. CAC scores were automatically derived from the low-dose attenuation correction CT scans using previously developed software based on deep learning. Obstructive CAD was defined as stenosis >70% (or >50% in the left main coronary artery) and/or fractional flow reserve (FFR) ≤0.80.In total 58% of patients had obstructive CAD of which seventy-four percent were male. Addition of CAC scores to MPI and clinical predictors significantly improved the diagnostic accuracy of MPI to detect obstructive CAD. The area under the curve (AUC) increased from 0.87 to 0.91 (p: 0.025). Sensitivity and specificity analysis showed an incremental decrease in false negative tests with our MPI + CAC approach (n = 14 to n = 4), as a consequence an increase in false positive tests was seen (n = 11 to n = 28).CAC scores collected simultaneously with MPI improve the detection of obstructive coronary artery disease in patients without a history of coronary revascularization.
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Objective
To investigate the incremental value of coronary flow reserve (CFR) assessed by cadmium zinc telluride(CZT)-SPECT as an adjunct to myocardial perfusion imaging (MPI) in the diagnosis of coronary artery disease (CAD).
Methods
Data of 132 patients (89 males, 43 females; 40-81 years) with or suspected with CAD who successfully underwent rest and stress MPI and CFR from November 2017 to October 2018 in Zhongshan Hospital Affiliated to Fudan University were retrospectively analyzed. Based on coronary angiography (CAG) as the gold standard , the value of MPI and MPI+ CFR in the diagnosis of CAD was evaluated and compared. χ2 test or Fisher exact probability test was used for data analysis.
Results
Of 132 patients, 61 (46.2%) were CAD with stenosis of at least 75% in one vessel (47.5%, 29/61), two vessels (34.4%, 21/61), or three vessels (18.0%, 11/61). A total of 104 (26.3%) vessels with stenosis of at least 75%, 25 (6.3%) vessels with stenosis of 65%-74%, and 30 (7.6%) vessels with stenosis of 50%-64% were found in 396 vessels. For detecting coronary stenosis of at least 75%, the sensitivity and accuracy of MPI on per-patient analysis were 86.89%(53/61) and 68.94%(91/132), which increased to 96.72%(59/61; χ2=3.921, P<0.05) and 87.88%(116/132; χ2=13.984, P<0.01) by MPI+ CFR. On per-vessel analysis, the sensitivity and accuracy of MPI were 72.12%(75/104) and 77.53%(307/396) and increased to 96.15%(100/104; χ2=22.511, P<0.01) and 85.10%(337/396; χ2=7.479, P<0.05) by MPI+ CFR. The sensitivity of MPI for predicting one, two, and three vessels disease were 72.41%(21/29), 42.86%(9/21), and 5/11 and were improved to 93.10%(27/29; χ2=4.350, P=0.037), 90.48%(19/21; χ2=10.714, P=0.001), and 11/11 (P=0.012) by MPI+ CFR. For coronary with stenosis of 65%-74%, the sensitivity of MPI was 24.00%(6/25) and was improved to 64.00%(16/25; χ2=8.117, P=0.004) by MPI+ CFR. For coronary with stenosis of 50%-64%, the sensitivity of MPI was 40.00%(12/30) and was improved to 76.67%(23/30; χ2=8.297, P=0.004) by MPI+ CFR.
Conclusion
As an adjunct to MPI, CFR can significantly improve the sensitivity and accuracy in the diagnosis of CAD, particularly for patients with mild stenosis and multivessel CAD.
Key words:
Coronary artery disease; Fractional flow reserve, myocardial; Myocardial perfusion imaging; Tomography, emission-computed, single-photon; Tellurium; Zinc; Cadmium
Coronary flow reserve
Fractional Flow Reserve
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Several studies have suggested that a combined approach of stress myocardial perfusion imaging (MPI) and coronary computed tomography angiography (CCTA) can provide diagnostic results with excellent accuracy. We aimed to explore whether the addition of CCTA to stress MPI provides incremental diagnostic value in intermediate-to-high cardiovascular risk patients.A total of 106 consecutive patients (93 male, 65 ± 10.4 years) underwent coronary artery calcium scoring (CACS), CCTA and (201)Thallium stress MPI before coronary angiography was reviewed. Thirty-seven patients (34.9%) had a history of proven coronary artery disease (CAD) or revascularization procedures, and four had documented non-significant CAD (3.8%). The remaining patients consisted of 17 (16.0%) classified as intermediate, and 48 (45.3%) as the high-risk groups.Obstructive CAD was diagnosed by invasive coronary angiography in 88 patients with 161 vessels. The sensitivity and specificity in a patient-based analysis for obstructive CAD were 99% and 17% for CCTA, 80% and 50% for MPI and 91% and 67% for the combined method, respectively. The per-vessel diagnostic sensitivity and specificity were 95% and 54% for CCTA, 59% and 75% for MPI and 84% and 76% for the combined method. There were significant differences (p < 0.05) when comparing the combined method with MPI or CCTA by areas under the curve in a patient- or vessel-based analysis. However, CACS of 400 or more could not further stratify the patients with obstructive CAD.CCTA, not CACS, provided additional diagnostic values to stress MPI in patients with intermediate-to-high cardiovascular risk.Coronary artery disease (CAD) • Coronary computed tomography angiography (CCTA) • Myocardial perfusion imaging (MPI) • Single-photon emission computed tomography (SPECT).
Computed Tomography Angiography
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