✍ Scribed by M. Hacker; T. Jakobs; F. Matthiesen; C. Vollmar; K. Nikolaou; C. Becker; A. Knez; T. Pfluger; R. Tiling; K. Hahn
No coin nor oath required. For personal study only.
Background: Appropriate diagnosis and therapy of coronary artery disease (CAD) frequently require information about both the functional and morphological status of the coronary artery tree. Aim of this retrospective analysis was to evaluate multislice spiral computed tomography angiography (MDCTA) compared to conventional coronary angiography (CCA) in terms of allocation of perfusion defects as detected by myocardial SPECT (MPI) to their determining coronary lesions in patients with advanced CAD. Methods: 20 patients with advanced CAD were retrospectively studied. Electrocardiographically gated MPI, MDCTA using a 16-detector CT scanner and CCA were performed in each patient. Reversible perfusion defects were subsequently allocated to their determining lesion separately for MDCTA and CCA. After this, MDCTA was compared to CCA in terms of lesion detection and lesion evaluation and in stating the correct diagnosis of CAD. In a third step, MDCTA and CCA were correlated in allocating reversible perfusion defects to their determining coronary lesions. Results: 20 patients (14 male, mean age 64 Ϯ 9.2 [48-79] years) were eligible. Correct diagnosis of CAD was stated in 14/20 patients by MDCTA. 33/47 coronary artery stenoses as detected by CCA showed coronary artery lesions including coronary stents in MDCTA, while 16/43 lesions in MDCTA were not correlated with any coronary stenosis in CCA. Sensitivity, specificity, NPV and PPV for MDCTA to detect stenoses Ն50% in 265 coronary segments for patients with advanced CAD were 46%, 97%, 92% and 73%, respectively. 5/5 reversible perfusion defects (PD) in MPI could be allocated to an appropriate coronary artery stenoses in CCA. Stenoses were located 4x in the LAD and 1x in the LCX. In MDCTA 5/5 reversible PD were allocated to the same lesions, all lesions were rated as Ն50%.
The preliminary results of the present study show high accuracy for MDCTA to allocate reversible perfusion defects in MPI to their determining coronary artery lesions in a small patient collective with advanced CAD. Further studies are needed to confirm these results for different subgroups of patients with suspected and known CAD.
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