Diagnostic accuracy of static CT perfusion for the detection of myocardial ischemia: A systematic review and meta-analysis

Mathias Holm Sørgaard; Klaus Fuglsang Kofoed; Jesper James Linde; Richard Thomas George; Carlos Eduardo Rochitte; Gudrun Feuchtner; Joao A C Lima; Jawdat Abdulla

doi:10.1016/j.jcct.2016.09.003

Diagnostic accuracy of static CT perfusion for the detection of myocardial ischemia: A systematic review and meta-analysis

Mathias Holm Sørgaard, Klaus Fuglsang Kofoed, Jesper James Linde, Richard Thomas George, Carlos Eduardo Rochitte, Gudrun Feuchtner, Joao A C Lima, Jawdat Abdulla

Department of Clinical Medicine

29 Citations (Scopus)

Abstract

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.

Original language	English
Journal	Journal of Cardiovascular Computed Tomography
Volume	10
Issue number	6
Pages (from-to)	450-457
Number of pages	8
ISSN	1934-5925
DOIs	https://doi.org/10.1016/j.jcct.2016.09.003
Publication status	Published - 1 Nov 2016

Keywords

Aged
Area Under Curve
Computed Tomography Angiography
Coronary Angiography
Coronary Circulation
Coronary Vessels
Female
Humans
Male
Middle Aged
Multidetector Computed Tomography
Myocardial Ischemia
Myocardial Perfusion Imaging
Predictive Value of Tests
ROC Curve
Reproducibility of Results
Journal Article
Meta-Analysis
Review

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Diagnostic accuracy of static CT perfusion for the detection of myocardial ischemia : A systematic review and meta-analysis. / Sørgaard, Mathias Holm; Kofoed, Klaus Fuglsang; Linde, Jesper James et al.

In: Journal of Cardiovascular Computed Tomography, Vol. 10, No. 6, 01.11.2016, p. 450-457.

Research output: Contribution to journal › Journal article › Research › peer-review

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abstract = "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.",

keywords = "Aged, Area Under Curve, Computed Tomography Angiography, Coronary Angiography, Coronary Circulation, Coronary Vessels, Female, Humans, Male, Middle Aged, Multidetector Computed Tomography, Myocardial Ischemia, Myocardial Perfusion Imaging, Predictive Value of Tests, ROC Curve, Reproducibility of Results, Journal Article, Meta-Analysis, Review",

author = "S{\o}rgaard, {Mathias Holm} and Kofoed, {Klaus Fuglsang} and Linde, {Jesper James} and George, {Richard Thomas} and Rochitte, {Carlos Eduardo} and Gudrun Feuchtner and Lima, {Joao A C} and Jawdat Abdulla",

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doi = "10.1016/j.jcct.2016.09.003",

language = "English",

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pages = "450--457",

journal = "Journal of Cardiovascular Computed Tomography",

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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

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 -

Diagnostic accuracy of static CT perfusion for the detection of myocardial ischemia: A systematic review and meta-analysis

Abstract

Keywords

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