Performance of Hybrid Imaging in the Diagnosis of Coronary Artery Disease

Abstract

Single-photon emission computed tomography (SPECT) and computed tomography coronary angiography (CTCA) are usually performed independently in patients with suspected coronary artery disease. We assessed the hypothesis that hybrid SPECT/CTCA imaging results in higher diagnostic accuracy than either method alone, particularly in cases presenting with high levels of coronary calcification. A total of 243 major coronary vessels in 81 patients with known or suspected coronary artery disease were screened using SPECT with semiconductor detectors and CTCA with 256-detector row computed tomography. Patients who were diagnosed with myocardial ischemia underwent coronary angiography. Coronary angiography results were defined as positive for stenosis when the stenosis diameter was >70% or fractional flow reserve was <0.8. These data were then compared with a fused image of the SPECT and CTCA datasets generated using a dedicated workstation. To detect significant coronary artery stenosis, the respective sensitivity, specificity, and accuracy were 73%, 61%, and 67% with SPECT alone, 96%, 44%, and 67% with CTCA alone, and 95%, 75%, and 84% with hybrid imaging. Moreover, hybrid imaging allowed the accurate diagnosis of 47 vessels with severe calcification that CTCA alone could not evaluate correctly. Hybrid imaging shows greater diagnostic accuracy than single-modality evaluation through more comprehensive information on potential coronary stenosis and its hemodynamic significance.