A1 Refereed original research article in a scientific journal
Impact of scan quality on the diagnostic performance of CCTA, SPECT, and PET for diagnosing myocardial ischemia defined by fractional flow reserve
Authors: P.A. van Diemen, R.S. Driessen, W.J. Stuijfzand, P.G. Raijmakers, S.P. Schumacher, M.J. Bom, H. Everaars, J.K. Min, J.A. Leipsic, J. Knuuti, S.R. Underwood, P.M. van de Ven, A.C. van Rossum, I. Danad, P. Knaapen
Publisher: Elsevier
Publication year: 2020
Journal: Journal of Cardiovascular Computed Tomography
Journal name in source: Journal of Cardiovascular Computed Tomography
Volume: 14
First page : 60
Last page: 67
ISSN: 1934-5925
eISSN: 1876-861X
DOI: https://doi.org/10.1016/j.jcct.2019.06.007
Background
Scan quality can have a significant effect on the diagnostic performance of non-invasive imaging techniques. However, the extent of its influence has scarcely been investigated in a head-to-head manner.
Methods
Two-hundred and eight patients underwent CCTA, SPECT, and PET prior to invasive fractional flow reserve measurements. Scan quality was classified as either good, moderate, or poor.
Results
Distribution of good, moderate, and poor quality scans was; CCTA; 66%, 22%, 13%; SPECT; 52%, 38%, 9%; PET; 86%, 13%, 1%. Good quality CCTA scans possessed a higher specificity (75% vs. 31%, p = 0.001), positive predictive value (PPV, 71% vs. 51%, p = 0.050), and accuracy (80% vs. 60%, p = 0.009) compared to moderate quality scans, while sensitivity (94%) and negative predictive value (NPV, 88%) were similar to moderate and poor quality scans. Sensitivity (76%), NPV (84%), and accuracy (85%) of good quality SPECT scans was superior to those of moderate (41% p = 0.001, 56% p = 0.010, 70% p = 0.010) and poor quality (30% p = 0.003, 65% p = 0.069, 63% p = 0.038). Specificity (92%) and PPV (87%) of good quality SPECT scans did not differ from scans of diminished quality. Good quality PET scans exhibited high sensitivity (84%), specificity (86%), NPV (88%), PPV (81%) and accuracy (85%), which was comparable to scans of lesser quality. Good quality CCTA, SPECT, and PET scans demonstrated a similar diagnostic accuracy (p = 0.247).
Conclusion
Diagnostic performance of CCTA, and SPECT is hampered by scan quality, while the diagnostic value of PET is not affected. Good quality CCTA, SPECT, and PET scans possess a high diagnostic accuracy.
