Purpose: To compare coronary computed tomography angiography (CTA) with single photon emission computed tomography-myocardial perfusion imaging (SPECT-MPI) for the detection of physiologically significant coronary artery disease (CAD). Materials and Methods: We evaluated 202 patients undergoing 64-slice coronary CTA and 201-Tl SPECT-MPI within a 3-month time interval. In addition, 68 patients underwent invasive coronary angiography (ICA). Coronary artery stenoses with luminal narrowing ≥50%

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... defined as "significant" on CTA and ICA. All myocardial segments were classified as reversible or fixed perfusion defects and normal segments on 201-Tl SPECT-MPI, and were allocated to the corresponding coronary vessels. Agreement and diagnostic performance between each imaging modality for physiologically significant CAD was calculated using the kappa (κ ) statistic and receiver operating characteristic analysis, respectively. Results: The sensitivity and specificity of CTA for the detection of physiologically significant CAD were 88% and 86% by patient-based analysis, and 84% and 91% by vessel-based analysis as compared to 201-Tl SPECT-MPI, respectively. The agreement between CTA and SPECTMPI was good (κ= 0.647) and moderate (κ= 0.558) by patientand vessel-based analyses, respectively. The accuracy of CTA for predicting perfusion defects on SPECT-MPI was comparable (area under the curve; 0.814 vs. 0.819, p=0.902 on patient-based analysis, and 0.808 vs. 0.749, p=0.197 on vessel-based analysis) to ICA. Conclusion: Coronary stenosis ≥50% on coronary CTA shows good agreement with perfusion defects in SPECT-MPI.