With, R.R. de (Ruben) (2015) Incremental value of rest myocardial perfusion using CT coronary angiography. thesis, Medicine.
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Abstract
Introduction The combination of rest and stress computed tomography (CT) has shown the potential to assess myocardial perfusion. Limited data is available on the diagnostic performance of rest CT perfusion (CTP) only. We hypothesize that rest CTP can have incremental diagnostic value due to use of coronary dilators in CT image acquisition. Objective (1) To establish the diagnostic accuracy of rest CTP compared to single photon emission CT (SPECT) perfusion and coronary angiography (ICA) and (2) to create a semi quantitative measurement of CT myocardial perfusion using custom made software. Methods Patients who underwent coronary CT, SPECT and ICA were included. Multiple readers assessed CT and SPECT perfusion using a 17-segment model on a 0-4 scale. ICA results were used for discordant outcomes. Custom made software using a similar algorithm as Kachenoura et al. was created to measure the regional CT myocardial to blood pool perfusion ratio (PR). Results were compared to visual CTP analysis. Results Data from 158 patients was analysed. Compared to rest SPECT, CTP sensitivity (SE) and specificity (SP) on a per patient basis were 77.6% and 59.3%, respectively. Compared to stress, SE was 77.9% and SP was 69.4%. CTP had a 63.0% SE and a 76.2% SP compared to rest SPECT per vascular territory. For stress, a 64.5% SE and an 80.4% SP were found. Semi quantitative analysis of CTP showed a SE of 28.6% and a SP of 83.3% compared to CTP visual analysis on a per patient basis. Conclusion (1) Visual analysis of MPI using rest CTP shows a good diagnostic accuracy compared to SPECT MPI. Overall diagnostic performance of rest CTP has a higher agreement with stress SPECT than rest SPECT. (2) Semi quantitative PR assessment had a poor diagnostic accuracy due to a lack of sensitivity.
| Item Type: | Thesis (Thesis) |
|---|---|
| Supervisor name: | Facultair begeleider: and Tio, dr. R.A. |
| Supervisor name: | Extern begeleider: and Chow, dr. B.J.W. and Instelling: University of Ottawa Heart Institute Afdeling: C and Ottawa, Canada |
| Faculty: | Medical Sciences |
| Date Deposited: | 25 Jun 2020 10:49 |
| Last Modified: | 25 Jun 2020 10:49 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/978 |
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