TY - JOUR
T1 - Diagnostic accuracy of static CT perfusion for the detection of myocardial ischemia
T2 - A systematic review and meta-analysis
AU - Sørgaard, Mathias Holm
AU - Kofoed, Klaus Fuglsang
AU - Linde, Jesper James
AU - George, Richard Thomas
AU - Rochitte, Carlos Eduardo
AU - Feuchtner, Gudrun
AU - Lima, Joao A C
AU - Abdulla, Jawdat
N1 - Copyright © 2016 Society of Cardiovascular Computed Tomography. Published by Elsevier Inc. All rights reserved.
PY - 2016/11/1
Y1 - 2016/11/1
N2 - OBJECTIVES: The aim of this study is to provide a meta-analysis of all published studies assessing the diagnostic accuracy of stress CT myocardial perfusion imaging (CTP) in patients suspected of or with known coronary artery disease. This analysis is limited to static stress CTP.METHODS: Systematic literature review and meta-analysis of studies examining the diagnostic accuracy of static CTP imaging alone or combined with coronary CT angiography (CTA) in comparison to single photon emission computed tomography (SPECT), magnetic resonance perfusion (MRP), and/or invasive coronary angiography with and without fractional flow reserve (FFR).RESULTS: The search revealed 19 eligible studies including 1188 patients. Pooled results showed that CTP had a good agreement with SPECT and MRP. On a per-patient level, sensitivity, specificity and AUC were 0.85 (95% CI: 0.70-0.93), 0.81 (95% CI: 0.59-0.93), 0.90 (95% CI: 0.87-0.92). On a per-artery level, sensitivity, specificity and AUC were 0.80 (95% CI: 0.67-0.88), 0.81 (95% CI: 0.72-0.88) and 0.87 (95% CI: 0.84-0.90). When invasive coronary angiography was used as reference standard, combined coronary CTA and CTP compared to coronary CTA alone significantly improved the specificity from 0.62 (95% CI: 0.52-0.70) to 0.84 (95% CI: 0.74-0.91) on a per-patient level (p = 0.008) and from 0.72 (95% CI: 0.63-0.79) to 0.90 (95% CI: 0.85-0.93) on a per-artery level (p = 0.0001) without significant decrease in sensitivity (p = 0.59 and p = 0.23, respectively).CONCLUSION: In selected patients, static CT myocardial perfusion has high diagnostic accuracy to detecting myocardial ischemia. Specificity increases significantly when CT myocardial perfusion is combined with coronary CTA.
AB - OBJECTIVES: The aim of this study is to provide a meta-analysis of all published studies assessing the diagnostic accuracy of stress CT myocardial perfusion imaging (CTP) in patients suspected of or with known coronary artery disease. This analysis is limited to static stress CTP.METHODS: Systematic literature review and meta-analysis of studies examining the diagnostic accuracy of static CTP imaging alone or combined with coronary CT angiography (CTA) in comparison to single photon emission computed tomography (SPECT), magnetic resonance perfusion (MRP), and/or invasive coronary angiography with and without fractional flow reserve (FFR).RESULTS: The search revealed 19 eligible studies including 1188 patients. Pooled results showed that CTP had a good agreement with SPECT and MRP. On a per-patient level, sensitivity, specificity and AUC were 0.85 (95% CI: 0.70-0.93), 0.81 (95% CI: 0.59-0.93), 0.90 (95% CI: 0.87-0.92). On a per-artery level, sensitivity, specificity and AUC were 0.80 (95% CI: 0.67-0.88), 0.81 (95% CI: 0.72-0.88) and 0.87 (95% CI: 0.84-0.90). When invasive coronary angiography was used as reference standard, combined coronary CTA and CTP compared to coronary CTA alone significantly improved the specificity from 0.62 (95% CI: 0.52-0.70) to 0.84 (95% CI: 0.74-0.91) on a per-patient level (p = 0.008) and from 0.72 (95% CI: 0.63-0.79) to 0.90 (95% CI: 0.85-0.93) on a per-artery level (p = 0.0001) without significant decrease in sensitivity (p = 0.59 and p = 0.23, respectively).CONCLUSION: In selected patients, static CT myocardial perfusion has high diagnostic accuracy to detecting myocardial ischemia. Specificity increases significantly when CT myocardial perfusion is combined with coronary CTA.
KW - Aged
KW - Area Under Curve
KW - Computed Tomography Angiography
KW - Coronary Angiography
KW - Coronary Circulation
KW - Coronary Vessels
KW - Female
KW - Humans
KW - Male
KW - Middle Aged
KW - Multidetector Computed Tomography
KW - Myocardial Ischemia
KW - Myocardial Perfusion Imaging
KW - Predictive Value of Tests
KW - ROC Curve
KW - Reproducibility of Results
KW - Journal Article
KW - Meta-Analysis
KW - Review
U2 - 10.1016/j.jcct.2016.09.003
DO - 10.1016/j.jcct.2016.09.003
M3 - Journal article
C2 - 27773634
SN - 1934-5925
VL - 10
SP - 450
EP - 457
JO - Journal of Cardiovascular Computed Tomography
JF - Journal of Cardiovascular Computed Tomography
IS - 6
ER -