Abstract
Background
The effective non-invasive identification of coronary artery disease (CAD) and its proper referral for invasive treatment are still unresolved issues. We evaluated our quantification of myocardium at risk (MAR) from our second generation 3D MPI/CTA fusion framework for the detection and localization of obstructive coronary disease.
Methods
Studies from 48 patients who had rest/stress MPI, CTA, and ICA were analyzed from 3 different institutions. From the CTA, a 3D biventricular surface of the myocardium with superimposed coronaries was extracted and fused to the perfusion distribution. Significant lesions were identified from CTA readings and positioned on the fused display. Three estimates of MAR were computed on the 3D LV surface on the basis of the MPI alone (MARp), the CTA alone (MARa), and the fused information (MARf). The extents of areas at risk were used to generate ROC curves using ICA anatomical findings as reference standard.
Results
Areas under the ROC curve (AUC) for CAD detection using MARf was 0.88 (CI = 0.75-0.95) and for MARp and MARa were, respectively 0.82 (CI = 0.69-0.92) and 0.75 (CI = 0.60-0.86) using the ≥70% stenosis criterion. AUCs for CAD localization (all vessels) using MARf showed significantly higher performance than either MARa or MARp or both.
Conclusions
Using ICA as the reference standard, MAR as the quantitative parameter, and AUC to measure diagnostic performance, MPI-CTA fusion imaging provided incremental diagnostic information compared to MPI or CTA alone for the diagnosis and localization of CAD.
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Abbreviations
- 1G:
-
First generation
- 2G:
-
Second generation
- MAR:
-
Myocardium at risk index
- MARp :
-
Physiological MAR
- MARa :
-
Anatomical MAR
- MARf :
-
Fused myocardium at risk
- MPR:
-
Multi-planar reformatting
- DS:
-
Degree of stenosis
- MIP:
-
Maximum intensity projections
- AUC:
-
Area under the ROC curve
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Acknowledgments
Our colleague Dr. Tracy L. Faber was the originator and leader of this project until her passing on March 24, 2012. This work was supported in part by NIH grant R01-HL-085417 from NHLBI. Dr. Piccinelli’s work was funded by a Postdoctoral grant from the AHA SE chapter award number 14POST20150001.
Disclosure
Some of the authors (EVG, RDF, CDC) receive royalties from the sale of the Emory Cardiac Toolbox and have equity positions with Syntermed, Inc. The terms of these arrangements have been reviewed and approved by Emory University in accordance with its conflict of interest policies. The remaining authors do not have any conflicts of interest.
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All editorial decisions for this article, including selection of reviewers and the final decision, were made by guest editor Andrew J. Einstein, MD, PhD, Associate Professor of Medicine (in Radiology), Columbia University.
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Piccinelli, M., Santana, C., Sirineni, G.K.R. et al. Diagnostic performance of the quantification of myocardium at risk from MPI SPECT/CTA 2G fusion for detecting obstructive coronary disease: A multicenter trial. J. Nucl. Cardiol. 25, 1376–1386 (2018). https://doi.org/10.1007/s12350-017-0819-x
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DOI: https://doi.org/10.1007/s12350-017-0819-x