2018 IJC (Single stress dataset CTP accuracy)

Background: Coronary computed tomography angiography (cCTA) has limited diagnostic accuracy in patients
with intermediate to high pre-test likelihood of coronary artery disease (CAD) that may have large amounts of
coronary calcium. Stress computed tomography myocardial perfusion (CTP) has emerged as a valuable strategy,
combining anatomical and functional assessment of CAD. Purpose of the study is to evaluate the diagnostic accuracy
of combining coronary artery imaging and myocardial perfusion in a single stress dataset versus invasive
coronary angiography (ICA) and invasive fractional flow reserve (FFR) as reference standard.
Methods: One-hundred-thirty consecutive symptomatic patients (age: 65± 9 years; men: 70%) scheduled for
clinically indicated ICA plus invasive FFR were prospectively enrolled. cCTA + CTP were simultaneously
evaluated in a single stress-dataset by blinded readers and compared to ICA and invasive FFR findings.
Results: CTPwas successfully performed in all patients. The most common artifacts observed in the stress dataset
for coronary artery imaging were blooming effect and motion effect related. Overall evaluability of coronary arteries
by using cCTA stress dataset was 93%. In a vessel and patient-based model, stress cCTA + stress CTP
showed sensitivity, specificity, negative predictive value, positive predictive value and diagnostic accuracy of
93%, 94%, 97%, 85%, 94%, and 98%, 86%, 98%, 85%, 92%, respectively. The overall effective dose (ED) of stress protocol
acquisition alone was 2.5±1.1 mSv.
Conclusions: Simultaneous evaluation of coronary arteries andmyocardial perfusion with single stress acquisition
is feasible and it has diagnostic accuracy and low ED to identify functionally significant stenosis in patients with
intermediate to high risk for CAD.