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Is there an incremental value to use myocardial perfusion imaging with or without CT attenuation for the diagnosis of coronary artery disease? A study in Chinese patients.

OBJECTIVE
To evaluate whether computed tomography attention correction (CTAC) has incremental diagnostic value for single photon emission tomography (SPET) myocardial perfusion imaging (MPI) for the detection of coronary artery disease (CAD) in Chinese patients.


SUBJECTS AND METHODS
This retrospective study consisted of 181 suspected CAD patients who underwent one-stop SPET examination by MPI combined with a CT scan. Two observers independently evaluated non-attenuation correction (NAC) and CTAC MPI images, and coronary angiography (CAG) results were used as reference standards. The diagnostic efficacies of the two methods were compared.


RESULTS
a) In the whole group, the sensitivity, specificity and accuracy for the detection of CAD were found to be 75.7%, 55.1% and 63.5% for NAC images and 52.7%, 86.9% and 72.9% for CTAC images, respectively; the areas under the receiver operating characteristic curves (AUC) were 0.654 and 0.698 (P>0.05). b) The accuracy of CTAC and the AUC were significantly higher than those for NAC in Chinese males. c) The accuracy of CTAC was also significantly increased for the right coronary artery (RCA) territory and in overweight patients (BMI≥24), although differences in the AUC were marginally insignificant.


CONCLUSION
Compared to NAC MPI, CTAC improved SPET MPI specificity but decreased sensitivity, leading to no obvious improvement in overall accuracy for the diagnosis of CAD in Chinese patients. However, CTAC might be of value in the subgroups of males and overweight patients and for the RCA territory. In routine clinical application, the integration of NAC and CTAC findings combined with CAD pre-test probability could improve MPI diagnostic performance.