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Nuklearmedizin 2007; 46(01): 29-35
DOI: 10.1055/s-0037-1616623
Original Article
Schattauer GmbH

Combined use of 64-slice computed tomography angiography and gated myocardial perfusion SPECT for the detection of functionally relevant coronary artery stenoses

First results in a clinical setting concerning patients with stable anginaKombination aus 64-Zeilen- CT-Angiographie und EKGgetriggerter Myokard-SPECT in der Detektion funktionell relevanter KoronarstenosenErste Ergebnisse bei Patienten mit stabiler Angina pectoris
M. Hacker   *
1   Department of Nuclear Medicine, University of Munich, Germany
,
T. Jakobs   *
2   Department of Clinical Radiology, University of Munich, Germany
,
N. Hack
1   Department of Nuclear Medicine, University of Munich, Germany
,
K. Nikolaou
2   Department of Clinical Radiology, University of Munich, Germany
,
C. Becker
2   Department of Clinical Radiology, University of Munich, Germany
,
F. von Ziegler
3   Department of Cardiology, Klinikum Grosshadern, University of Munich, Germany
,
A. Knez
3   Department of Cardiology, Klinikum Grosshadern, University of Munich, Germany
,
A. König
4   Department of Cardiology, Medizinische Poliklinik-Innenstadt, University of Munich, Germany
,
V. Klauss
4   Department of Cardiology, Medizinische Poliklinik-Innenstadt, University of Munich, Germany
,
R. Tiling
1   Department of Nuclear Medicine, University of Munich, Germany
› Author Affiliations
Further Information

Publication History

Received: 01 August 2006

accepted in revised form: 18 September 2006

Publication Date:
08 January 2018 (online)

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Summary

Aim: In patients with stable angina pectoris both morphological and functional information about the coronary artery tree should be present before revascularization therapy is performed. High accuracy was shown for spiral computed tomography (MDCT) angiography acquired with a 64-slice CT scanner compared to invasive coronary angiography (ICA) in detecting „obstructive” coronary artery disease (CAD). Gated myocardial SPECT (MPI) is an established method for the noninvasive assessment of functional significance of coronary stenoses. Aim of the study was to evaluate the combination of 64-slice CT angiography plus MPI in comparison to ICA plus MPI in the detection of hemodynamically relevant coronary artery stenoses in a clinical setting. Patients, methods: 30 patients (63 ± 10.8 years, 23 men) with stable angina (21 with suspected, 9 with known CAD) were investigated. MPI, 64-slice CT angiography and ICA were performed, reversible and fixed perfusion defects were allocated to determining lesions separately for MDCT angiography and ICA. The combination of MDCT angiography plus MPI was compared to the results of ICA plus MPI. Results: Sensitivity, specificity, negative and positive predictive value for the combination of MDCT angiography plus MPI was 85%, 97%, 98% and 79%, respectively, on a vessel-based and 93%, 87%, 93% and 88%, respectively, on a patient-based level. 19 coronary arteries with stenoses ≥50% in both ICA and MDCT angiography showed no ischemia in MPI. Conclusion: The combination of 64-slice CT angiography and gated myocardial SPECT enabled a comprehensive non-invasive view of the anatomical and functional status of the coronary artery tree.

Zusammenfassung

Zur Therapieplanung und insbesondere vor revaskularisierenden Maßnahmen bei symptomatischen Patienten sollten sowohl Informationen zur Koronarmorphologie als auch zum funktionellen Status des Herzens vorliegen. Für die 64-Zeilen-CT-Angiographie wurde eine hohe Treffsicherheit im Vergleich zur invasiven Koronarangiographie (ICA) in der Detektion einer „obstruktiven” koronaren Herzerkrankung (KHE) gezeigt. Die Myokardperfusionsszintigraphie (MPI) ist eine etablierte Methode zur nicht invasiven Abklärung funktionell signifikanter Koronarstenosen. Ziel der Studie war der Vergleich der Kombination aus 64-Zeilen- CT-Angiographie plus MPI mit der Kombination aus ICA plus MPI in der Detektion hämodynamisch relevanter Koronarstenosen. Patienten, Methoden: 30 Patienten (63 ± 10,8 Jahre, 23 Männer) mit stabiler Angina pectoris (21 mit Verdacht auf und 9 mit bekannter KHE) wurden mit MPI, 64-Zeilen-CT-Angiographie und ICA untersucht. Reversible Perfusionsdefekte in der MPI wurden den entsprechenden Koronarstenosen getrennt für 64-Zeilen-CT-Angiographie und ICA zugeordnet. Die Kombination aus 64-Zeilen-CT-Angiographie plus MPI wurde mit den Ergebnissen von ICA plus MPI verglichen. Ergebnisse: Sensitivität, Spezifität, negativer und positiver prädiktiver Wert für die Kombination aus 64-Zeilen-CT-Angiographie plus MPI errechneten sich gefäßbasiert zu 85%, 97%, 98% und 79%, sowie patientenbasiert zu 93%, 87%, 93% und 88%. 19 Koronararterien mit signifikanten Stenosen sowohl in der ICA als auch in der 64-Zeilen-CT-Angiographie zeigten in der MPI keine Ischämie. Schlussfolgerung: Die Kombination aus 64-Zeilen-CT-Angiographie und gated SPECT ermöglicht einen umfassenden nicht invasiven Einblick in den morphologischen und funktionellen Status des Koronarbaumes.

Keywords

Myocardial perfusion SPECT - 64-slice spiral CT angiography - invasive coronary angiography - coronary artery disease - stable angina pectoris

Schlüsselwörter

Myokardszintigraphie - SPECT - 64-Zeilen-CT-Angiographie - invasive Koronarangiographie - koronare Herzerkrankung - stabile Angina pectoris

* Dres. Hacker and Jakobs equally contributed to this work.


 

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