MDCT stress-rest perfusion methods were recently described as adjunctive tools to improve CTA accuracy for detection of functionally significant CAD. However, only a few studies compared these MDCT-IP with other clinically validated perfusion techniques like CMR-Perf. Furthermore, CTP has never been validated against the invasive reference standard, fractional flow reserve (FFR), in patients with suspected CAD.
101 symptomatic patients with suspected CAD (62 ¡À 8.0 years, 67 % males) and intermediate/high pre-test probability underwent MDCT, CMR and invasive coronary angiography. Functionally significant CAD was defined by the presence of occlusive/subocclusive stenoses or FFR measurements ¡Ü0.80 in vessels >2mm.
On a patient-based model, the MDCT-IP had a sensitivity, specificity, positive and negative predictive values of 89 % , 83 % , 80 % and 90 % , respectively (global accuracy 85 % ). These results were closely related with those achieved by CMR-Perf: 89 % , 88 % , 85 % and 91 % , respectively (global accuracy 88 % ). When comparing test accuracies using noninferiority analysis, differences greater than 11 % in favour of CMR-Perf can be confidently excluded.
MDCT protocols integrating CTA and stress-rest perfusion detect functionally significant CAD with similar accuracy as CMR-Perf. Both approaches yield a very good accuracy. Integration of CTP and CTA improves MDCT performance for the detection of relevant CAD in intermediate to high pre-test probability populations.