Research ArticleCLINICAL INVESTIGATIONS

Quantitative Measures of Coronary Stenosis Severity by 64-Slice CT Angiography and Relation to Physiologic Significance of Perfusion in Nonobese Patients: Comparison with Stress Myocardial Perfusion Imaging

Akira Sato, Michiaki Hiroe, Mieko Tamura, Hirokazu Ohigashi, Toshihiro Nozato, Hiroyuki Hikita, Atsushi Takahashi, Kazutaka Aonuma and Mitsuaki Isobe
Journal of Nuclear Medicine April 2008, 49 (4) 564-572; DOI: https://doi.org/10.2967/jnumed.107.042481

Article Figures & Data

Figures

  • FIGURE 1. 
    FIGURE 1. 

    Window settings for lumen and outer vessel boundary by CTA are the same as those for IVUS imaging. (A) Curved multiplanar reconstructed CTA image reveals significant stenosis in left anterior descending artery (arrow). (B) IVUS cross-section reveals lumen area of 2.1 mm2 and vessel area of 15.4 mm2. Cross-sectional CTA images show luminal CSA of 2.1 mm2 (C) and vessel CSA of 15.4 mm2 (D).

  • FIGURE 2. 
    FIGURE 2. 

    A 65-y-old woman with chest pain. (A) CTA image using maximum-intensity projection reveals presence of significant stenosis in proximal left anterior descending artery (arrow). (C) Minimal luminal CSA is 2.6 mm2. (D) Vessel CSA is 20.9 mm2. (B) Corresponding tomograms show reversible perfusion abnormality in anterior, septal, and apical wall (arrows). S.A = short axis; V.L.A = vertical long axis; H.L.A = horizontal long axis.

  • FIGURE 3. 
    FIGURE 3. 

    A 63-y-old man with chest pain. (A) CTA image using maximum-intensity projection shows noncalcified plaque in left anterior descending artery (arrow). (C) Minimal luminal CSA is 4.2 mm2. (D) Vessel CSA is 12.5 mm2. (B) Corresponding tomograms show normal perfusion at peak exercise and rest. S.A = short axis; V.L.A = vertical long axis; H.L.A = horizontal long axis.

  • FIGURE 4. 
    FIGURE 4. 

    (A) Correlation between lumen CSAs measured by 64-slice CTA and IVUS (n = 32). Dashed lines correspond to correlation of calcified plaques (n = 12, y = 0.74x + 1.34, r = 0.55, P = 0.09), whereas solid lines correspond to correlation of noncalcified plaques (n = 20, y = 0.88x + 0.66, r = 0.91, P < 0.0001). (B) Bland–Altman analysis of differences between the lumen CSAs (mean difference, 0.27 ± 0.64 mm2). Dashed lines correspond to mean ± 2 SDs (−1.01 to 1.55 mm2). (C) Correlations between percentage stenosis measured by 64-slice CTA and IVUS (n = 32). Dashed lines correspond to correlation of calcified plaques (n = 12, y = 0.61x + 30.1, r = 0.73, P = 0.0069), whereas solid lines correspond to correlation of noncalcified plaques (n = 20, y = 0.88x + 8.43, r = 0.87, P < 0.0001). (D) Bland–Altman analysis of differences between percentage stenosis (mean difference, −0.22% ± 11%). Dashed lines correspond to mean ± 2 SDs (−11.2% to 10.7%). Open circles indicate noncalcified plaques, whereas solid circles indicate calcified plaques.

  • FIGURE 5. 
    FIGURE 5. 

    Prevalence of reversible defects evaluated by SPECT in study groups defined according to percentage stenosis obtained by CTA. Numbers under the bars represent number of vessels. *P = 0.018. **P < 0.0001 vs. percentage stenosis of 0%–60%.

  • FIGURE 6. 
    FIGURE 6. 

    (A) Quantitative perfusion defects in relation to percentage stenosis by CTA. (B) Quantitative perfusion defects in relation to minimal luminal CSA. Open circles indicate negative SPECT, and solid circles indicate positive SPECT.

  • FIGURE 7. 
    FIGURE 7. 

    Diagnostic value of CTA measurements for assessment of functionally significant coronary artery stenosis using stress 201Tl SPECT. ROC curves of lesion luminal CSA (A) and lesion percentage stenosis (B).

Tables

  • TABLE 1

    Characteristics of Patients (n = 104)

    CharacteristicValue
    Age (y)66.9 ± 11
    Male/female76/28
    Hypertension (%)55 (53%)
    Hyperlipidemia (%)57 (55%)
    Diabetes (%)41 (39%)
    Smoking (%)47 (45%)
    BMI (kg/m2), median (IQR)23.8 (21.1–25.6)
    Symptoms
     Anginal chest pain65 (62%)
     Atypical chest pain22 (21%)
    Pretest likelihood of CAD
     Low6 (6%)
     Intermediate78 (75%)
     High20 (19%)
    Resting ECG
     Negative T7 (7%)
     ST depression14 (13%)
     Left ventricular hypertrophy25 (24%)

    • BMI = body mass index; IQR = interquartile range.

  • TABLE 2

    Comparison of 64-Slice CTA Measurements According to Stress 201Tl SPECT Results

    Lesion
    SPECT resultMinimal luminal CSA (mm2)Vessel CSA (mm2)Plaque CSA (mm2)Stenosis (%)
    (+) (n = 48)2.8 ± 0.6*13.5 ± 5.810.6 ± 5.576.6 ± 7.9*
    (−) (n = 57)4.9 ± 1.414.0 ± 4.29.2 ± 3.764.1 ± 10.8

    • ↵* P < 0.0001 vs. SPECT (−).

  • TABLE 3

    Diagnostic Accuracy of Functionally Significant Coronary Artery Stenosis According to Stenosis Severity by 64-Slice CTA

    Stenosis criterion (%)Sensitivity (%)Specificity (%)PPV (%)NPV (%)
    Vessels for analysis only with evaluable vessels
    >6098845599
    >7079926696
    >8038988689
    All vessels for analysis with positive nonevaluable vessels
    >6098774699
    >7081845196
    >8043904889
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