Journal of the Korean Society of Radiology (대한영상의학회지)

The Korean Society of Radiology (대한영상의학회)
권호 표지

Evaluation of Agreement between 64-slice Computed Tomography Angiography and 201-Tl Single Photon Emission Computed Tomography-myocardial Perfusion Imaging in the Diagnosis of Significant Coronary Artery Disease

의미 있는 관상동맥질환의 진단을 위한 64절편 관상동맥 CT조영술과 201-TI SPECT-심근관류영상의 일치도 평가

  • Ma, Jee-Hyun (Department of Radiology, Ajou University School of Medicine) ;
  • Kang, Doo-Kyoung (Department of Radiology, Ajou University School of Medicine) ;
  • Lee, Su-Jin (Department of Nuclear Medicine, Ajou University School of Medicine) ;
  • An, Young-Sil (Department of Nuclear Medicine, Ajou University School of Medicine) ;
  • Lim, Hong-Seok (Department of Cardiology, Ajou University School of Medicine)
  • 마지현 (아주대학교 의과대학 영상의학교실) ;
  • 강두경 (아주대학교 의과대학 영상의학교실) ;
  • 이수진 (아주대학교 의과대학 핵의학과학교실) ;
  • 안영실 (아주대학교 의과대학 핵의학과학교실) ;
  • 임홍석 (아주대학교 의과대학 순환기내과학교실)
  • Published : 2011.06.01
⟨ Previous Next ⟩

Abstract

Purpose: To compare coronary computed tomography angiography (CTA) with single photon emission computed tomography-myocardial perfusion imaging (SPECT-MPI) for the detection of physiologically significant coronary artery disease (CAD). Materials and Methods: We evaluated 202 patients undergoing 64-slice coronary CTA and 201-Tl SPECT-MPI within a 3-month time interval. In addition, 68 patients underwent invasive coronary angiography (ICA). Coronary artery stenoses with luminal narrowing ${\geq}$50% were defined as "significant" on CTA and ICA. All myocardial segments were classified as reversible or fixed perfusion defects and normal segments on 201-Tl SPECT-MPI, and were allocated to the corresponding coronary vessels. Agreement and diagnostic performance between each imaging modality for physiologically significant CAD was calculated using the kappa ($\kappa$) statistic and receiver operating characteristic analysis, respectively. Results: The sensitivity and specificity of CTA for the detection of physiologically significant CAD were 88% and 86% by patient-based analysis, and 84% and 91% by vessel- based analysis as compared to 201-Tl SPECT-MPI, respectively. The agreement between CTA and SPECTMPI was good ($\kappa$= 0.647) and moderate ($\kappa$= 0.558) by patientand vessel-based analyses, respectively. The accuracy of CTA for predicting perfusion defects on SPECT-MPI was comparable (area under the curve; 0.814 vs. 0.819, p=0.902 on patient-based analysis, and 0.808 vs. 0.749, p=0.197 on vessel-based analysis) to ICA. Conclusion: Coronary stenosis ${\geq}$50% on coronary CTA shows good agreement with perfusion defects in SPECT-MPI.

목적: 관류결손을 보이는 의미 있는 관상동맥질환을 발견하는 데 있어 관상동맥 CT 조영술을 심근관류영상과 비교하고자 하였다. 대상과 방법: 64-절편 CT 조영술 및 201-Tl SPECT-심근관류영상을 시행한 202명의 환자를 대상으로 하였다. 침습적 혈관조영술이 68명에서 추가로 시행되었다. 관상동맥의 직경이 50% 이상 감소한 경우 의미 있는 협착으로 간주하고, 심분절은 심근관류 정도에 따라 가역성, 비가역성 그리고 정상으로 분류하여 각 심분절을 해당 관상동맥과 비교하였다. 생리학적으로 의미 있는 협착을 진단하는 각 영상진단방법 사이의 일치도를 Kappa 통계를 이용하여 분석하고, receiver operating characteristic 분석으로 진단 정확도를 비교하였다. 결과: CT 조영술의 민감도 및 특이도는 환자를 대상으로 각각 88%와 86%, 혈관을 대상으로 84%와 91%이었다. CT 조영술과 SPECT-심근관류영상 사이에 환자를 대상으로 좋은 일치도($\kappa$= 0.647), 혈관을 대상으로 중등도($\kappa$= 0.558)의 일치도를 보였다. CT 조영술의 진단 정확도는 침습적 혈관조영술과 대등하였다. 결론: CT 조영술에서 직경 50% 이상의 협착은 심근관류영상의 관류결손 부위와 통계적으로 의미 있는 일치도를 보인다.

Keywords

References

  1. Klocke FJ, Baird MG, Lorell BH, Bateman TM, Messer JV, Berman DS, et al. ACC/AHA/ASNC guidelines for the clinical use of cardiac radionuclide imaging: executive summary - a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (ACC/ AHA/ASNC Committee to Revise the 1995 Guidelines for the Clinical Use of Cardiac Radionuclide Imaging). J Am Coll Cardiol 2003;42:1318-1333 https://doi.org/10.1016/j.jacc.2003.08.011
  2. Topol EJ, Nissen SE. Our preoccupation with coronary luminology. The dissociation between clinical and angiographic findings in ischemic heart disease. Circulation 1995;92:2333-2342 https://doi.org/10.1161/01.CIR.92.8.2333
  3. White CW, Wright CB, Doty DB, Hiratza LF, Eastham CL, Harrison DG, et al. Does visual interpretation of the coronary arteriogram predict the physiologic importance of a coronary stenosis? N Engl J Med 1984;310:819-824 https://doi.org/10.1056/NEJM198403293101304
  4. Leber AW, Knez A, von Ziegler F, Becker A, NikolaouK, Paul S, et al. Quantification of obstructive and nonobstructive coronary lesions by 64-slice computed tomography: a comparative study with quantitative coronary angiography and intravascular ultrasound. J Am Coll Cardiol 2005;46:147-154 https://doi.org/10.1016/j.jacc.2005.03.071
  5. Ropers D, Rixe J, Anders K, Kuttener A, Baum U, Bautz W, et al. Usefulness of multidetector row spiral computed tomography with 64- ${\times}$ 0.6-mm collimation and 330-ms rotation for the noninvasive detection of significant coronary artery stenoses. Am J Cardiol 2006;97:343-348 https://doi.org/10.1016/j.amjcard.2005.08.050
  6. Leber AW, Knez A, Becker A, Becker C, Ziegler F, Nikolaou K, et al. Accuracy of multidetector spiral computed tomography in identifying and differentiating the composition of coronary atherosclerotic plaques: a comparative study with intracoronary ultrasound. J Am Coll Cardiol 2004;43:1241-1247 https://doi.org/10.1016/j.jacc.2003.10.059
  7. Schuijf JD, Wijns W, Jukema JW, Atsma DE, Roos A, Lamb HJ, et al. Relationship between noninvasive coronary angiography with multi-slice computed tomography and myocardial perfusion imaging. J Am Coll Cardiol 2006;48:2508-2514 https://doi.org/10.1016/j.jacc.2006.05.080
  8. Hacker M, Jakobs T, Hack N, Nikolaou K, Becker C, Ziegler F, et al. Sixty-four slice spiral CT angiography does not predict the functional relevance of coronary artery stenoses in patients with stable angina. Eur J Nucl Med Mol Imaging 2007;34:4-10 https://doi.org/10.1007/s00259-006-0207-2
  9. Gaemperli O, Schepis T, Valenta I, Koepfli P, Husmann L, Scheffel H, et al, Kaufmann PA. Functionally relevant coronary artery disease: comparison of 64-section CT angiography with myocardial perfusion SPECT. Radiology 2008;248:414-423 https://doi.org/10.1148/radiol.2482071307
  10. Morise A, Evans M, Jalisi F, Shetty R, Stauffer M. A pretest prognostic score to assess patients undergoing exercise or pharmacological stress testing. Heart 2007;93:200-204
  11. McCollough CH. Patient dose in cardiac computed tomography. Herz 2003;28:1-6 https://doi.org/10.1007/s00059-003-2447-2
  12. Dewey M, Rutsch W, Schnapauff D, Teige F, Hamm B. Coronary artery stenosis quantification using multislice computed tomography. Invest Radiol 2007;42:78-84 https://doi.org/10.1097/01.rli.0000251569.01317.60
  13. Cordeiro MA, Lardo AC, Brito MS, Neto MA, Siqueira MH, Parga JR, et al. CT angiography in highly calcified arteries: 2D manual vs. modified automated 3D approach to identify coronary stenoses. Int J Cardiovasc Imaging 2006;22:507-516 https://doi.org/10.1007/s10554-005-9044-9
  14. Leber AW, Johnson T, Becker A, Ziegler F, Tittus J, Nikolaou K, et al. Diagnostic accuracy of dual-source multi-slice CT-coronary angiography in patients with an intermediate pretest likelihood for coronary artery disease. Eur Heart J 2007;28:2354-2360 https://doi.org/10.1093/eurheartj/ehm294
  15. Cerqueira MD, Weissman NJ, Dilsizian V, Jacobs AK, Kaul S, Laskey WK, et al. Standardized myocardial segmentation and nomenclature for tomographic imaging of the heart: a statement for healthcare professionals from the Cardiac Imaging Committee of the Council on Clinical Cardiology of the American Heart Association. Circulation 2002;105:539-542 https://doi.org/10.1161/hc0402.102975
  16. Austen WG, Edwards JE, Frye RL, Gensini GG, Gott VL, Griffith LS, et al. A reporting system on patients evaluated for coronary artery disease. Report of the Ad Hoc Committee for Grading of Coronary Artery Disease, Council on Cardiovascular Surgery, American Heart Association. Circulation 1975;51:5-40 https://doi.org/10.1161/01.CIR.51.4.5
  17. Meng L, Cui L, Cheng Y, Wu X, Tang Y, Wang Y, et al. Effect of heart rate and coronary calcification on the diagnostic accuracy of the dual-source CT coronary angiography in patients with suspected coronary artery disease. Korean J Radiol 2009;10:347-354 https://doi.org/10.3348/kjr.2009.10.4.347
  18. Altman DG, Bland JM. Diagnostic tests 2: predictive values. BMJ 1994;309:102
  19. Tamarappoo BK, Gutstein A, Cheng VY, Nakazato R, Gransar H, Dey D, et al. Assessment of the relationship between stenosis severity and distribution of coronary artery stenoses on multislice computed tomographic angiography and myocardial ischemia detected by single photon emission computed tomography. J Nucl Cardiol 2010;17:791-802 https://doi.org/10.1007/s12350-010-9230-6
  20. Gaemperli O, Schepis T, Koepfli P, Valenta I, Soyka J, Leschka S, et al. Accuracy of 64-slice CT angiography for the detection of functionally relevant coronary stenoses as assessed with myocardial perfusion SPECT. Eur J Nucl Med Mol Imaging 2007;34:1162-1171 https://doi.org/10.1007/s00259-006-0307-z
  21. Nicol ED, Schultz C, Stirrup J, Roughton M, Padley SP, Rubens MB, et al. Defining the appropriate CTA stenosis threshold for gatekeeping to invasive angiography: 50% or 70%? Int J Cardiol 2010;144:297-298 https://doi.org/10.1016/j.ijcard.2009.02.031
  22. Gaemperli O, Husmann L, Schepis T, Koepfli P, Valenta I, Jenni W, et al. Coronary CT angiography and myocardial perfusion imaging to detect flow-limiting stenoses: a potential gatekeeper for coronary revascularization? Eur Heart J 2009;30:2921-2929 https://doi.org/10.1093/eurheartj/ehp304
  23. Rocha-Filho JA, Blankstein R, Shturman LD, Bezerra HG, Okada DR, Rogers IS, et al. Incremental value of adenosine-induced stress myocardial perfusion imaging with dual-source CT at cardiac CT angiography. Radiology 2010;254:410-419 https://doi.org/10.1148/radiol.09091014
  24. Hacker M, Jakobs T, Matthiesen F, Nikolaou K, Becker C, Knez A, et al. Combined functional and morphological imaging consisting of gated myocardial perfusion SPECT and 16-detector multislice spiral CT angiography in the noninvasive evaluation of coronary artery disease: first experiences. Clin Imaging 2007;31:313-320 https://doi.org/10.1016/j.clinimag.2007.03.013
  25. Hausleiter J, Meyer T, Hadamitzky M, Kastrati A, Martinoff S, Schomig A. Prevalence of noncalcified coronary plaques by 64-slice computed tomography in patients with an intermediate risk for significant coronary artery disease. J Am Coll Cardiol 2006;48:312-318 https://doi.org/10.1016/j.jacc.2006.02.064
  26. Chung SY, Lee KY, Chun EJ, Lee WW, Park EK, Chang HJ, et al. Comparison of stress perfusion MRI and SPECT for detection of myocardial ischemia in patients with angiographically proven three-vessel coronary artery disease. AJR Am J Roentgenol 2010;195:356-362 https://doi.org/10.2214/AJR.08.1839