Assessment of coronary artery disease severity by positron emission tomography. Comparison with quantitative arteriography in 193 patients

L L Demer, K L Gould, R A Goldstein, R L Kirkeeide, N A Mullani, R W Smalling, A Nishikawa, M E Merhige
1989 Circulation  
To assess the accuracy of positron emission tomography (PET) for evaluation of coronary artery disease (CAD), cardiac PET perfusion images were obtained at rest and with dipyridamolehandgrip stress in 193 patients undergoing coronary arteriography. PET images were reviewed by two independent readers blinded to clinical data. Subjective defect severity scores were assigned to each myocardial region on a 0 (normal) to 5 (severe) scale. Results were compared with arteriographic stenosis severity
more » ... stenosis severity expressed as stenosis flow reserve (SFR), with continuous values ranging from 0 (total occlusion) to 5 (normal), calculated from quantitative arteriographic dimensions using automated detection of the vessel borders. There were 115 patients with significant CAD (SFR<3), 37 patients with mild CAD (3.SFR<4), and 41 patients with essentially normal coronaries (SFR.4). With increasingly severe impairment of stenosis flow reserve, subjective PET defect severity increased. Despite wide scatter, a PET score of 2 or more was highly predictive of significant flow reserve impairment (SFR <3). For each patient, the score of the most severe PET defect correlated with the SFR of that patient's most severe stenosis (r,=0.77±0.06). For each of 243 stenoses, PET defect score correlated with the SFR of the corresponding artery (r,=0.63±0.08). PET defect location closely matched the region supplied by the diseased artery, and readers agreed whether the most severe PET defect was less than or more than 2 for 89% of patients. (Circulation 1989;79:825-835) M y yocardial perfusion imaging is widely used for noninvasive assessment of stenosis V severity. Knowledge of the diagnostic accuracy of these tests is important for proper clinical application and interpretation. Most previous reports of the diagnostic accuracy of myocardial perfusion imaging1-4 have used sensitivity-
doi:10.1161/01.cir.79.4.825 pmid:2784361 fatcat:nbgjrolmfvhivkkvo7wc4znr2a