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Detection of Hemodynamically Significant Coronary Artery Stenosis: Incremental Diagnostic Value of Dynamic CT-based Myocardial Perfusion Imaging.
MedLine Citation:
PMID:  21846761     Owner:  NLM     Status:  In-Data-Review    
Abstract/OtherAbstract:
Purpose: To determine the feasibility of computed tomography (CT)-based dynamic myocardial perfusion imaging for the detection of hemodynamically significant coronary artery stenosis, as defined with fractional flow reserve (FFR). Materials and Methods: Institutional review board approval and informed patient consent were obtained before patient enrollment in the study. The study was HIPAA compliant. Subjects who were suspected of having or were known to have coronary artery disease underwent electrocardiographically triggered dynamic stress myocardial perfusion imaging. FFR measurement was performed within all main coronary arteries with a luminal narrowing of 50%-85%. Estimated myocardial blood flow (MBF) was derived from CT images by using a model-based parametric deconvolution method for 16 myocardial segments and was related to hemodynamically significant coronary artery stenosis with an FFR of 0.75 or less in a blinded fashion. Conventional measures of diagnostic accuracy were derived, and discriminatory power analysis was performed by using logistic regression analysis. Results: Of 36 enrolled subjects, 33 (mean age, 68.1 years ± 10 [standard deviation]; 25 [76%] men, eight [24%] women) completed the study protocol. An MBF cut point of 75 mL/100 mL/min provided the highest discriminatory power (C statistic, 0.707; P <.001). While the diagnostic accuracy of CT for the detection of anatomically significant coronary artery stenosis (>50%) was high, it was low for the detection of hemodynamically significant stenosis (positive predictive value [PPV] per coronary segment, 49%; 95% confidence interval [CI]: 36%, 60%). With use of estimated MBF to reclassify lesions depicted with CT angiography, 30 of 70 (43%) coronary lesions were graded as not hemodynamically significant, which significantly increased PPV to 78% (95% CI: 61%, 89%; P = .02). The presence of a coronary artery stenosis with a corresponding MBF less than 75 mL/100 mL/min had a high risk for hemodynamic significance (odds ratio, 86.9; 95% CI:17.6, 430.4). Conclusion: Dynamic CT-based stress myocardial perfusion imaging may allow detection of hemodynamically significant coronary artery stenosis. © RSNA, 2011 Supplemental material: http://radiology.rsna.org/lookup/suppl/doi:10.1148/radiol.11110638/-/DC1.
Authors:
Fabian Bamberg; Alexander Becker; Florian Schwarz; Roy P Marcus; Martin Greif; Franz von Ziegler; Ron Blankstein; Udo Hoffmann; Wieland H Sommer; Verena S Hoffmann; Thorsten R C Johnson; Hans-Christoph R Becker; Bernd J Wintersperger; Maximilian F Reiser; Konstantin Nikolaou
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Radiology     Volume:  260     ISSN:  1527-1315     ISO Abbreviation:  Radiology     Publication Date:  2011 Sep 
Date Detail:
Created Date:  2011-08-17     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0401260     Medline TA:  Radiology     Country:  United States    
Other Details:
Languages:  eng     Pagination:  689-98     Citation Subset:  AIM; IM    
Affiliation:
Departments of Clinical Radiology and Cardiology, Ludwig-Maximilians University, Klinikum Grosshadern, Marchioninistrasse 15, 81377 Munich, Germany; Cardiac MR PET CT Program, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass; Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass.
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