Author + information
- Received February 2, 2009
- Revision received May 18, 2009
- Accepted June 2, 2009
- Published online September 15, 2009.
- Ron Blankstein, MD⁎,†,⁎ (, )
- Leon D. Shturman, MD⁎,
- Ian S. Rogers, MD, MBA⁎,
- Jose A. Rocha-Filho, MD⁎,
- David R. Okada, MD⁎,
- Ammar Sarwar, MD⁎,
- Anand V. Soni, MD⁎,
- Hiram Bezerra, MD⁎,‡,
- Brian B. Ghoshhajra, MD, MBA⁎,
- Milena Petranovic, MD⁎,
- Ricardo Loureiro, MD⁎,
- Gudrun Feuchtner, MD⁎,§,
- Henry Gewirtz, MD⁎,
- Udo Hoffmann, MD, MPH⁎,
- Wilfred S. Mamuya, MD, PhD⁎∥,
- Thomas J. Brady, MD⁎ and
- Ricardo C. Cury, MD⁎,¶
- ↵⁎Reprint requests and correspondence:
Dr. Ron Blankstein, Cardiac MR PET CT Program, Department of Radiology and Division of Cardiology, Massachusetts General Hospital, 165 Cambridge Street, Suite 400, Boston, Massachusetts 02114
Objectives This study sought to determine the feasibility of performing a comprehensive cardiac computed tomographic (CT) examination incorporating stress and rest myocardial perfusion imaging together with coronary computed tomography angiography (CTA).
Background Although cardiac CT can identify coronary stenosis, very little data exist on the ability to detect stress-induced myocardial perfusion defects in humans.
Methods Thirty-four patients who had a nuclear stress test and invasive angiography were included in the study. Dual-source computed tomography (DSCT) was performed as follows: 1) stress CT: contrast-enhanced scan during adenosine infusion; 2) rest CT: contrast-enhanced scan using prospective triggering; and 3) delayed scan: acquired 7 min after rest CT. Images for CTA, computed tomography perfusion (CTP), and single-photon emission computed tomography (SPECT) were each read by 2 independent blinded readers.
Results The DSCT protocol was successfully completed for 33 of 34 subjects (average age 61.4 ± 10.7 years; 82% male; body mass index 30.4 ± 5 kg/m2) with an average radiation dose of 12.7 mSv. On a per-vessel basis, CTP alone had a sensitivity of 79% and a specificity of 80% for the detection of stenosis ≥50%, whereas SPECT myocardial perfusion imaging had a sensitivity of 67% and a specificity of 83%. For the detection of vessels with ≥50% stenosis with a corresponding SPECT perfusion abnormality, CTP had a sensitivity of 93% and a specificity of 74%. The CTA during adenosine infusion had a per-vessel sensitivity of 96%, specificity of 73%, and negative predictive value of 98% for the detection of stenosis ≥70%.
Conclusions Adenosine stress CT can identify stress-induced myocardial perfusion defects with diagnostic accuracy comparable to SPECT, with similar radiation dose and with the advantage of providing information on coronary stenosis.
This study was supported in part by a grant from Astellas, Inc. Drs. Blankstein, Shturman, Rogers, and Soni have received support from National Institutes of Health grant 1T32 HL076136. Dr. Hoffmann has received research grants from GE Healthcare, Bracco Diagnostics, and Bayer Healthcare. Dr. Cury has received research grant support from Astellas Pharma, Inc.
- Received February 2, 2009.
- Revision received May 18, 2009.
- Accepted June 2, 2009.
- American College of Cardiology Foundation