Investigation of Coronary Artery Disease by Coronary Computed Tomography Angiography and the Diagnostic Value of First-pass Myocardial Perfusion Imaging without Stress

Abstract

Aim: We aimed to investigate the diagnostic accuracy of first-pass computed tomography (CT) myocardial perfusion imaging (CT-MPI) without stress in combination with coronary CT angiography (CCTA) to detect coronary artery stenosis leading to myocardial ischemia compared to invasive coronary angiography (ICA) as the reference standard. Materials and Methods: A total of 68 patients and 195 vessels were included in the study. We performed CCTA and first pass CT-MPI without stress on all patients. With ICA as the primary reference, the diagnostic accuracies of CCTA and CCTA plus first pass CT-MPI were expressed in terms of sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) for the detection of vascular territories with significant obstructive coronary artery disease (CAD). Results: CCTA plus first pass CT-MPI without stress yielded the following results for vascular territory detection with more than 50% coronary stenosis (as determined with ICA): sensitivity, 80%; specificity, 87%; PPV, 61.5%; and NPV, 94.4%. In addition, the ability of the area under the receiver operating characteristic curve for CCTA plus first-pass CT-MPI to distinguish coronary stenosis was markedly improved compared to CCTA alone. Conclusion: CCTA plus first-pass CT-MPI without stress does not require additional radiation or contrast agent and additionally provides information about myocardial perfusion and coronary stenosis.

Keywords

• coronary artery disease
• coronary computed tomography angiography
• first-pass myocardial perfusion without stress