angiography with I nvasive C oronary angiography Ibrahim Danad, - - PowerPoint PPT Presentation

Prospective compArison of CardIac PET/CT, SPECT/CT perFusion imaging and CT coronary angiography with Invasive Coronary angiography

Ibrahim Danad, Pieter G. Raijmakers, Roel S. Driessen, Jonathon Leipsic, Rekha Raju, Chris Naoum, Juhani Knuuti, Maija Maki, Richard Underwood, James K. Min, Kimberly Elmore, Wynand J. Stuijfzand, Niels van Royen, Igor I. Tulevski, Aernout G. Somsen, Marc C.

• Huisman. Arthur van Lingen, Martijn W. Heymans, Peter M. van de Ven, Cornelis van Kuijk2,

Adriaan A. Lammertsma, Albert C. van Rossum, and Paul Knaapen*

The PACIFIC-trial

• To determine the diagnostic value, in a true

head-to-head fashion, of CCTA, SPECT and PET imaging compared against Fractional Flow Reserve

• To assess whether cardiac hybrid imaging has

an incremental diagnostic value over stand- alone imaging

Aim of the study

6 min. 6 min. Adenosine 140 µg/kg/min

[15O]H2O [15O]H2O

Stress perfusion Resting perfusion LD CT LD CT Scout CT Calcium scoring 256-slice CTCA 2 min. Contrast injection 99m-Tc LD CT Stress SPECT LD CT Rest SPECT 99m-Tc ICA + FFR

Day 1 Day 2

Study design

Results - Diagnostic accuracy

Sensitivity Specificity NPV PPV Accuracy 20 40 60 80 100

CCTA SPECT PET

90% 57% 87% 60% 94% 84% 89% 73% 89% 64% 88% 81% 74%77% 85%

Percentage (%)

Results - Diagnostic accuracy hybrid imaging

Sensitivity Specificity NPV PPV Accuracy 20 40 60 80 100

Hybrid SPECT/CCTA Hybrid PET/CCTA

50% 74% 97% 92% 71% 82% 94% 88% 76% 84%

Percentage (%)

Conclusion

• This first prospective head-to-head comparative trial revealed PET to exhibit the

highest accuracy for diagnosis of myocardial ischemia in patients with an intermediate pre-test likelihood

• A combined anatomical and functional assessment does not add incremental

diagnostic value and guides clinical decision-making in an unsalutary fashion