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Original article
CT stress perfusion imaging for detection of haemodynamically relevant coronary stenosis as defined by FFR
  1. Martin Greif1,
  2. Franz von Ziegler1,
  3. Fabian Bamberg2,
  4. Janine Tittus1,
  5. Florian Schwarz2,
  6. Melvin D'Anastasi2,
  7. Roy P Marcus2,
  8. Jan Schenzle1,
  9. Christoph Becker2,
  10. Konstantin Nikolaou2,
  11. Alexander Becker1
  1. 1Department of Cardiology, Klinikum Grosshadern, University Hospital of Munich, Munich, Bayern, Germany
  2. 2Department of Radiology, Klinikum Grosshadern, University Hospital of Munich, Munich, Bayern, Germany
  1. Correspondence to Dr Martin Greif, Department of Cardiology, Klinikum Grosshadern, University Hospital of Munich, Marchioninistrasse 15, Munich 81377, Bayern, Germany; martin.greif{at}med.uni-muenchen.de

Abstract

Objectives To evaluate the diagnostic accuracy (DA) of CT-myocardial perfusion imaging (CT-MPI) and a combined approach with CT angiography (CTA) for the detection of haemodynamically relevant coronary stenoses in patients with both suspected and known coronary artery disease.

Design Prospective, non-randomised, diagnostic study.

Setting Academic hospital-based study.

Patients 65 patients (42 men age 70.4±9) with typical or atypical chest pain.

Interventions CTA and CT-MPI with adenosine stress using a fast dual-source CT system. At subsequent invasive angiography, FFR measurement was performed in coronary arteries to define haemodynamic relevance of stenosis.

Main outcome measures We tried to correlate haemodynamically relevant stenosis (FFR < 0.80) to a reduced myocardial blood flow (MBF) as assessed by CT-MPI and determined the DA of CT-MPI for the detection of haemodynamically relevant stenosis.

Results Sensitivity and negative predictive value (NPV) of CTA alone were very high (100% respectively) for ruling out haemodynamically significant stenoses, specificity, Positive predictive value (PPV) and DA were low (43.8, 67.3 and 72%, respectively). CT-MPI showed a significant increase in specificity, PPV and DA for the detection of haemodynamically relevant stenoses (65.6, 74.4 and 81.5%, respectively) with persisting high sensitivity and NPV for ruling out haemodynamically relevant stenoses (97% and 95.5% respectively). The combination of CTA and CT-MPI showed no further increase in detection of haemodynamically significant stenosis compared with CT-MPI alone.

Conclusions Our data suggest that CT-MPI permits the detection of haemodynamically relevant coronary artery stenoses with a moderate DA. CT may, therefore, allow the simultaneous assessment of both coronary morphology and function.

  • Imaging and diagnostics

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