Comparison of multi-slice CT (MSCT) and Tl-201 myocardial SPECT in detection of coronary artery disease; relation to coronary arteriography

Abstract

Aim: To evaluate the diagnostic potentials of MSCT and Tl-201 SPECT in the assessment of coronary artery disease. Methods: Twenty-four patients (15 men, 9 women, 42–79 years) with clinically suspected coronary artery disease (CAD) were studied by Tl-201 myocardial SPECT and MSCT. MSCT data were obtained with 12 × 0.75 mm, 420ms rotation, 16 slice multi-detector raw CT scanner (SOMATOM Sensation, Siemens) using non-ionic contrast, 80ml, 4ml/sec. Multiplanar reconstruction techniques were used for evaluation of coronary arteries. Tl-201 myocardial SPECT were performed at stress with adenosine and at rest. Data from MSCT and Tl-201 SPECT were compared territory by territory (divided into two segments; LAD and RCA/LCx) and related to coronary arteriography, in which more than 60% stenoses are regarded as significant. Results: MSCT and Tl-201 SPECT showed agreement in 35 out of 48 segments (73%). Out of 13 disagreed segments (27%), Tl-201 SPECT was superior in 8 segments and MSCT was superior in 5 segments. Sensitivities and specificities of MSCT and Tl-201 SPECT by coronary arteriography are 81.8%, 73.0% and 86.3%, 80.7%, respectively. Two segments in agreement between MSCT and SPECT were different from the results of coronary arteriography. Myocardial bridge in two cases were detected as significant stenoses by MSCT but showed normal perfusion in Tl-201 SPECT. Conclusion: MSCT and Tl-201 SPECT exhibited good agreement in the assessment of coronary artery disease, but, Tl-201 SPECT has higher sensitivity and specificity for the detection of jeopardized myocardium than MSCT. In the assessment of coronary artery disease, CT angiography using MSCT could be useful non-invasive diagnostic tool with complementary information of Tl-201 SPECT.