Detection of myocardial infarction by dual-source coronary computed tomography angiography using quantitated myocardial scintigraphy as the reference standard

Ronen Rubinshtein, T. D. Miller, E. E. Williamson, J. Kirsch, R. J. Gibbons, A. N. Primak, C. H. McCollough, P. A. Araoz

Research output: Contribution to journalArticlepeer-review

29 Scopus citations

Abstract

Background: Dual-source coronary computed tomography angiography (DS-CTA) has the potential to assess both coronary anatomy and myocardial perfusion. We studied the ability of DS-CTA to detect myocardial infarction (MI) compared to a reference standard of technetium Tc99m sestamibi single photon emission computed tomography (SPECT). Methods: 122 patients with suspected or known coronary artery disease (age 60 (SD 11) years, 36% females) were evaluated by both DS-CTA and SPECT. SPECT-MI size was quantitated using a threshold value of 60% of peak counts on the resting images. MI on DS-CTA was defined as transmural or subendocardial hypoenhancement (<50% of surrounding myocardium), which persisted in both diastolic and systolic reconstructions and was concordant with a coronary artery territory. The performance of DS-CTA to detect SPECT-MI was determined in a blinded, vessel-based analysis. Results: 366 vessel territories were analysed (122 patients x3). SPECT revealed 20 vessel territories with MI (involving 17 patients). 15/20 (75%) of these vessel territories were also detected by DS-CTA. An additional seven MIs were detected by DS CTA only (considered as false positive). Thus, the sensitivity of DS-CTA for detection of SPECT-MI was 75% (95% CI 56% to 94%), specificity 98% (97% to 100%), positive predictive value 68% (49% to 88%) and negative predictive value 99% (97% to 100%). DS-CTA detected 10/11 (91%) larger MIs (involving >5% of left ventricular (LV) mass by SPECT). For the 15 concordant MIs (in both SPECT and DS-CTA) the mean difference in MI size between modalities was 0.5% (4.6%) of LV mass (95% CI -8.6% to 9.5%). Conclusions: DS-CTA myocardial perfusion imaging showed moderate sensitivity and positive predictive value but high specificity and negative predictive value for detection of SPECT-MI. Most large infarcts (>5% of LV mass) were detected by DS-CTA. When MI was detected by both modalities, there was a good correlation between infarct sizes quantitated by DS-CTA vs SPECT.

Original languageEnglish (US)
Pages (from-to)1419-1422
Number of pages4
JournalHeart
Volume95
Issue number17
DOIs
StatePublished - Sep 2009

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Fingerprint Dive into the research topics of 'Detection of myocardial infarction by dual-source coronary computed tomography angiography using quantitated myocardial scintigraphy as the reference standard'. Together they form a unique fingerprint.

Cite this