Namdar Mehdi, Hany Thomas F, Koepfli Pascal, Siegrist Patrick T, Burger Cyrill, Wyss Christophe A, Luscher Thomas F, von Schulthess Gustav K, Kaufmann Philipp A
Nuclear Cardiology Section, Division of Cardiology, Cardiovascular Center NUK C 32, University Hospital, Raemistrasse 100, CH-8091 Zurich, Switzerland.
J Nucl Med. 2005 Jun;46(6):930-5.
An accurate, noninvasive technique for the diagnosis of coronary artery disease (CAD) should provide complementary information on coronary anatomy and pathophysiologic lesion severity. We present, what is to our knowledge, the first clinical evaluation of integrated PET/CT for combined acquisition of coronary anatomy and perfusion.
On an integrated PET/CT scanner, contrast-enhanced CT angiography (CTA) and rest/adenosine-stress myocardial perfusion scanning with (13)N-ammonia were performed on 25 patients with CAD documented by coronary angiography. Contrast-enhanced CTA was performed with retrospective electrocardiography gating after injection of 150 mL of intravenous contrast medium. Decisions on whether to treat with revascularization (anatomic lesion plus ischemia) or conservatively (no lesion or no ischemia) based on PET/CT were compared with those based on PET plus coronary angiography.
Of the 100 coronary artery segments (left main, left anterior descending, left circumflex, and right in 25 patients), 7 (in 5 patients) were considered impossible to evaluate by CT because of rapid vessel movement but were correctly categorized by PET alone. In the remaining 93 segments, the sensitivity and specificity of PET/CT versus PET plus coronary angiography were 90% and 98%, respectively. Positive and negative predictive values were 82% and 99%, and accuracy was 97%.
The data of this preliminary study suggest that PET/CT allows accurate noninvasive clinical decision making about CAD. Because of its high negative predictive value, PET/CT may play an important role in noninvasive selection of CAD patients for revascularization. Integration of higher-performance multislice spiral CT scanners into PET/CT hybrids will accelerate the clinical implementation of this technique.
一种准确、无创的冠状动脉疾病（CAD）诊断技术应能提供关于冠状动脉解剖结构和病理生理病变严重程度的补充信息。据我们所知，我们首次对用于联合采集冠状动脉解剖结构和灌注情况的PET/CT进行了临床评估。
在一台PET/CT一体机上，对25例经冠状动脉造影证实患有CAD的患者进行了对比增强CT血管造影（CTA）以及静息/腺苷负荷心肌灌注扫描（使用(^{13}N) - 氨）。在注射150 mL静脉造影剂后，采用回顾性心电图门控技术进行对比增强CTA检查。将基于PET/CT做出的关于是否进行血运重建治疗（解剖病变加缺血）或保守治疗（无病变或无缺血）的决策与基于PET加冠状动脉造影做出的决策进行比较。
在25例患者的100个冠状动脉节段（左主干、左前降支、左旋支和右冠状动脉）中，有7个节段（5例患者）因血管快速移动被CT认为无法评估，但仅通过PET就被正确分类。在其余93个节段中，PET/CT相对于PET加冠状动脉造影的敏感性和特异性分别为90%和98%。阳性预测值和阴性预测值分别为82%和99%，准确性为97%。
这项初步研究的数据表明，PET/CT能够对CAD进行准确的无创临床决策。由于其高阴性预测值，PET/CT在无创选择CAD患者进行血运重建方面可能发挥重要作用。将更高性能的多层螺旋CT扫描仪集成到PET/CT一体机中将加速该技术的临床应用。
