Abstract
Background
The consequences of atherosclerosis can be detected by multislice computed tomography (MSCT), invasive coronary angiogram (CAG) and the resultant myocardial ischaemia by myocardial perfusion single photon emission computed tomography (MPS). In this study an attempt is made to compare MSCT with MPS and also to compare the MSCT findings with that of invasive CAG in patients suspected to have coronary artery disease (CAD).
Materials and methods
A total of 99 patients suspected to have CAD underwent both MSCT and MPS with 99mTc sestamibi. The MSCT studies were classified as having no CAD, significant CAD (>50% diameter stenosis), and insignificant CAD (<50% diameter stenosis). Myocardial perfusion single photon emission computed tomography was reported as normal and reversible ischaemia. In a subgroup of 33 patient invasive CAG was done.
Results
In 99 patients, 396 coronaries were evaluated with MSCT and MPS. Coronary artery calcium scoring (CACS) in these patient ranged from 0 to 2200. No CAD was noted in 128 (32%) coronaries but MPS was found abnormal in 9 (7%) coronaries. Insignificant CAD was noted in 169 (43%) coronaries amongst which reversible ischaemia was noted in 23 (14%). Significant CAD was noted in 99 (25%) coronaries of which only 54 (55%) were MPS positive for reversible ischaemia. The MSCT has a negative predictive value (NPV) of 97%. When MSCT was normal, MPS was almost normal, but the reverse was not true. That is when MPS was normal MSCT was not always normal but showed lesion of insignificant obstruction.
In the subset of 33 patients, who underwent invasive angiogram, 132 coronaries were evaluated. Coronary angiogram showed 48 coronaries (36%) to have significant CAD (>50% diameter stenosis). Multislice computed tomography correlated well in 46 (84%) with P value of <0.001 (χ2-test) but for 9 (16%) showing overestimation due to increased CACS (>800). Myocardial perfusion single photon emission computed tomography was normal in 15 (27%) coronaries.
Conclusion
Myocardial perfusion single photon emission computed tomography provides functional information of the anatomical lesions and MSCT provides anatomical information. Both are two different diagnostic modalities. The MSCT has high NPV in patients with less likelihood for CAD. When compared with CAG, the correlation with MSCT was good and is useful where the calcium score is low.
Keywords: Coronary artery disease, Ischaemia, MSCT, 99mTc sestamibi
References
- 1.Enas EA, Yusuf S, Mehta JL. Prevalence of coronary artery disease in Asian Indians. Am J Cardiol. 1992;70:945–949. doi: 10.1016/0002-9149(92)90744-j. [DOI] [PubMed] [Google Scholar]
- 2.Begom R, Singh RB. Prevalence of coronary artery diseases and its risk factors in the urban population of south and north India. Acta Cardiol. 1995;50:227–240. [PubMed] [Google Scholar]
- 3.Bulatao RA, Stephend PW. Global estimates and projection of mortality by cause. Population, Health and Nutrition Department, World Bank, preworking paper; Washington DC: 1992. p. 1007. [Google Scholar]
- 4.Hacker M, Jacobs T, Muttherisen F. Comparison of spiral multidetector CT angiography and myocardial perfusion imaging in the noninvasive detection of functionally relevant coronary artery lesions; first clinical experiences. J Nucl Med. 2005;46:1294–1300. [PubMed] [Google Scholar]
- 5.Hachamovitch R, Hayes SW, Friedman JD, Cohen I, Berman DS. Comparison of the short term survival benefit associated with revascularisation compared with medical therapy in patients with no prior coronary artery disease undergoing stress myocardial perfusion single photon emission computed tomography. Circulation. 2003;107:2000–2007. doi: 10.1161/01.CIR.0000072790.23090.41. [DOI] [PubMed] [Google Scholar]
- 6.Schuijf JD, Wijns W, Lukema JW. Relationship between non invasive coronary angiography with multisclie computed tomography and myocardial perfusion imaging. J Am Coll Cardiol. 2006;48:2508–2514. doi: 10.1016/j.jacc.2006.05.080. [DOI] [PubMed] [Google Scholar]
- 7.Ripler S, Roguin A, Keidar Z. Integrated SPECT/CT for the assessment of hemodynamically significant coronary artery lesions; first clinical experiences. J Nuc Med. 2005;46:1294–3000. [Google Scholar]
- 8.Giovanni Lucignani. The emergence of MRI and MSCT cardiac imaging; nuclear cardiology is not the only actor on stage. Eur J Nucl Med Mol Imaging. 2007;34:787–793. doi: 10.1007/s00259-007-0416-3. [DOI] [PubMed] [Google Scholar]
- 9.Schuijf JD, Wijns W, Jukema JW. A Comparative regional analysis of coronary atherosclerosis and calcium score on multi-slice CT versus myocardial perfusion on SPECT. J Nucl Med. 2006;47:1749–1755. [PubMed] [Google Scholar]
- 10.Klock FJ, Bairde MG, Lorell BH. ACC/AHA/ASNA guidelines for the clinical use of cardiac radionuclide imaging-executive summary. A report of American College of Cardiology/American Heart Association Task Force on practice guidelines (ACC/AHA/ASNC Committee to revise the guidelines for the clinical use of cardiac radionuclide imaging) J Am Coll Cardiol. 2003;42:1318–1333. doi: 10.1016/j.jacc.2003.08.011. [DOI] [PubMed] [Google Scholar]
- 11.Nathan D, Rozanski A, Gransar H. Metablic syndrome and diabetics are associated with an increased likelihood of inducible myocardial ischemia among patients with subclinical atherosclerosis. Diabetics Care. 2005;28:1445–1450. doi: 10.2337/diacare.28.6.1445. [DOI] [PubMed] [Google Scholar]
- 12.Hacker M, Jakobs T, Hack N. Combined use of 64 slice computed tomography angiography and gated myocardial perfusion SPECT for the detection of functionally relevant coronary artery stenosis-first results in a clinical setting concerning patient with stable angina. Nuklear Medizin. 2007;46:29–35. [PubMed] [Google Scholar]
- 13.Hoffmann U, Ferencik M, Cury RC, Pena AJ. Coronary CT angiography. J Nucl Med. 2006;47:797–806. [PubMed] [Google Scholar]
- 14.Halon DA, Gasper T, Adawi S. Uses and limitations of 40 slice multidetector row spiral computed tomography for diagnosing coronary lesions in unselected patients referred for routine invasive coronary angiography. Cardiology. 2006;108:200–209. doi: 10.1159/000096778. [DOI] [PubMed] [Google Scholar]
- 15.Bax JJ, Schuijf JD. Which patients should be referred for non invasive angiography with multislice CT. Int J Cardiol. 2007;114:1–3. doi: 10.1016/j.ijcard.2006.08.008. [DOI] [PubMed] [Google Scholar]