SPECT myocardial perfusion imaging as an adjunct to coronary calcium score for the detection of hemodynamically significant coronary artery stenosis

BMC Cardiovascular Disorders

Research Article

Michaela Brendel¹  Gerhard Steinbeck¹  Alexander Becker¹  Martin Greif¹  Franz von Ziegler¹  Janine Ruemmler¹  Susanne Helbig¹  Christoph Becker²  Marcus Hacker³  Christopher Uebleis³ 

[1] University of Munich, Department of Cardiology, Campus Grosshadern, Munich, Germany;University of Munich, Department of Clinical Radiology, Campus Grosshadern, Munich, Germany;University of Munich, Department of Nuclear Medicine, Campus Grosshadern, Munich, Germany;

关键词: Computed tomography coronary calcium scoring;    Single photon emission computed tomography myocardial perfusion imaging;    Invasive coronary angiography;    Coronary artery disease;   

DOI  :  10.1186/1471-2261-12-116

 received in 2012-05-10, accepted in 2012-11-30,  发布年份 2012

来源: Springer

【 摘 要 】

BackgroundCoronary artery calcifications (CAC) are markers of coronary atherosclerosis, but do not correlate well with stenosis severity. This study intended to evaluate clinical situations where a combined approach of coronary calcium scoring (CS) and nuclear stress test (SPECT-MPI) is useful for the detection of relevant CAD.MethodsPatients with clinical indication for invasive coronary angiography (ICA) were included into our study during 08/2005-09/2008. At first all patients underwent CS procedure as part of the study protocol performed by either using a multidetector computed tomography (CT) scanner or a dual-source CT imager. CAC were automatically defined by dedicated software and the Agatston score was semi-automatically calculated. A stress-rest SPECT-MPI study was performed afterwards and scintigraphic images were evaluated quantitatively. Then all patients underwent ICA. Thereby significant CAD was defined as luminal stenosis ≥75% in quantitative coronary analysis (QCA) in ≥1 epicardial vessel. To compare data lacking Gaussian distribution an unpaired Wilcoxon-Test (Mann–Whitney) was used. Otherwise a Students t-test for unpaired samples was applied. Calculations were considered to be significant at a p-value of <0.05.ResultsWe consecutively included 351 symptomatic patients (mean age: 61.2±12.3 years; range: 18–94 years; male: n=240) with a mean Agatston score of 258.5±512.2 (range: 0–4214). ICA verified exclusion of significant CAD in 66/67 (98.5%) patients without CAC. CAC was detected in remaining 284 patients. In 132/284 patients (46.5%) with CS>0 significant CAD was confirmed by ICA, and excluded in 152/284 (53.5%) patients. Sensitivity for CAD detection by CS alone was calculated as 99.2%, specificity was 30.3%, and negative predictive value was 98.5%. An additional SPECT in patients with CS>0 increased specificity to 80.9% while reducing sensitivity to 87.9%. Diagnostic accuracy was 84.2%.ConclusionsIn patients without CS=0 significant CAD can be excluded with a high negative predictive value by CS alone. An additional SPECT-MPI in those patients with CS>0 leads to a high diagnostic accuracy for the detection of CAD while reducing the number of patients needing invasive diagnostic procedure.

【 授权许可】

CC BY   
© von Ziegler et al.; licensee BioMed Central Ltd. 2012