Combined quantitative assessment of myocardial perfusion and coronary artery calcium score by hybrid 82Rb PET/CT improves detection of coronary artery disease

Yafim Brodov, Heidi Gransar, Damini Dey, Aryeh Shalev, Guido Germano, John D. Friedman, Sean W. Hayes, Louise E.J. Thomson, André Rogatko, Daniel S. Berman, Piotr J. Slomka

Research output: Contribution to journalArticlepeer-review

32 Scopus citations

Abstract

Hybrid PET myocardial perfusion imaging (MPI) with CT allows the incorporation of coronary artery calcium (CAC) into the clinical protocol. We aimed to determine whether the combined analysis of MPI and CAC could improve the diagnostic accuracy of PET MPI in detection of obstructive coronary artery disease (CAD). Methods: Consecutive patients (n 5 152; mean age ± SD, 69 ± 12 y) without prior CAD, referred to 82Rb PET MPI followed by invasive coronary angiography performed within 14 days, were studied. Myocardial perfusion was quantified automatically for left anterior descending, left circumflex, and right coronary artery territories as an ischemic total perfusion deficit (ITPD) for 456 vessels. Global and per-vessel CAC Agatston scores were calculated. Obstructive CAD was defined as 50% or greater stenosis of the left main and 70% or greater stenosis in the left anterior descending, left circumflex, and right coronary arteries. Logistic regression and 10-fold cross validation were used to derive and validate the combined ITPD/logCAC (logarithm of coronary calcium) scores. Results: In the prediction of per-vessel obstructive CAD, the receiver-operating-characteristic area under the curve for combined per-vessel ITPD/logCAC score was higher, 0.85 (95% confidence interval [CI], 0.81-0.89), than standalone ITPD area under the curve, 0.81 (95% CI: 0.76-0.85), and logCAC score, 0.73 (95% CI, 0.68-0.78; P < 0.05). The integrated discrimination improvement of combined per-vessel ITPD/logCAC analysis was 0.07 (95% CI, 0.04-0.09; P < 0.0001), as compared with ITPD alone. Conclusion: Combined automatically derived per-vessel ITPD and logCAC score improves accuracy of 82Rb PET MPI for detection of obstructive CAD.

Original languageEnglish
Pages (from-to)1345-1350
Number of pages6
JournalJournal of Nuclear Medicine
Volume56
Issue number9
DOIs
StatePublished - 1 Sep 2015
Externally publishedYes

Keywords

  • Coronary calcium score
  • Detection of obstructive coronary artery disease
  • Hybrid cardiac positron emission tomography

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

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