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Detection of Myocardial Infarction by Dual-Source Coronary Computer Tomography Angiography Using Quantitated Myocardial Scintigraphy as the Reference Standard
  1. Ronen Rubinshtein (rubinshteinr{at}gmail.com)
  1. Mayo Clinic, United States
    1. Todd D Miller (miller.todd{at}mayo.edu)
    1. Mayo Clinic, United States
      1. Eric E Williamson (ewilliamson{at}mayo.edu)
      1. Mayo Clinic, United States
        1. Jacobo Kirsch (kirschj{at}gmail.com)
        1. Mayo Clinic, United States
          1. Raymond J Gibbons (gibbons.raymond{at}mayo.edu)
          1. Mayo Clinic, United States
            1. Andrew N Primak (primak.andrew{at}mayo.edu)
            1. Mayo Clinic, United States
              1. Cynthia H McCollough (mccollough.cynthia{at}mayo.edu)
              1. Mayo Clinic, United States
                1. Philip A Araoz (paraoz{at}mayo.edu)
                1. Mayo Clinic, United States

                  Abstract

                  Background: Dual source coronary CT angiography (DS-CTA) has the potential to assess both coronary anatomy and myocardial perfusion. We studied the ability of DS-CTA to detect myocardial infarction (MI) compared to a reference standard of Tc99m sestamibi Single Photon Emission Computed Tomography (SPECT).

                  Methods: 122 patients with suspected or known coronary artery disease (age: 60±11 years, 36% females) were evaluated by both DS-CTA and SPECT. SPECT-MI size was quantitated using a threshold value of 60% of peak counts on the resting images. MI on DS-CTA was defined as transmural or subendocardial hypoenhancement (< 50% of surrounding myocardium) which persisted in both diastolic and systolic reconstructions and was concordant with a coronary artery territory. The performance of DS-CTA to detect SPECT-MI was determined in a blinded, vessel-based analysis.

                  Results: 366 vessel territories were analyzed (122 patients x3). SPECT revealed 20 vessel territories with MI (involving 17 patients). 15/20 (75%) of these vessel territories were also detected by DS-CTA. An additional 7 MI’s were detected by DS CTA only (considered as false positive). Thus, the sensitivity of DS-CTA for detection of SPECT-MI was 75% (95% CI, 56-94), specificity 98% (97-100), positive predictive value 68% (49-88) and negative predictive value 99% (97-100). DS-CTA detected 10/11 (91%) of larger MI's [involving >5% of left ventricular (LV) mass by SPECT]. For the 15 concordant MI's (in both SPECT and DS-CTA) mean difference in MI size between modalities was 0.5±4.6% of LV mass (95% CI, -8.6% to 9.5%).

                  Conclusions: DS-CTA myocardial perfusion imaging showed moderate sensitivity and positive predictive value but high specificity and negative predictive value for detection of SPECT-MI. Most large infarcts (>5% of LV mass) were detected.

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