Comparison of the Extent and Severity of Myocardial Perfusion Defects Measured by CT Coronary Angiography and SPECT Myocardial Perfusion Imaging

Balaji K. Tamarappoo, Damini Dey, Ryo Nakazato, Haim Shmilovich, Thomas Smith, Victor Y. Cheng, Louise E.J. Thomson, Sean W. Hayes, John D. Friedman, Guido Germano, Piotr J. Slomka, Daniel S. Berman*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


Objectives: We compared electrocardiogram-gated computed tomography (CT) myocardial perfusion imaging (MPI) based on quantification of the extent and severity of perfusion abnormalities to that measured with single-photon emission computed tomography (SPECT) MPI. Background: Contrast-enhanced CT-MPI has been used for the identification of myocardial ischemia. Methods: We performed CT-MPI during intravenous adenosine infusion in 30 patients with perfusion abnormalities on rest/adenosine stress SPECT-MPI acquired within 60 days (18 stress-rest CT-MPI and 12 stress CT-MPI only). The extent and severity of perfusion defects on SPECT-MPI were assessed on a 5-point scale in a standard 17-segment model, and total perfusion deficit (TPD) was quantified by automated software. The extent and severity of perfusion defects on CT-MPI was visually assessed by 2 observers using the same grading scale and expressed as summed stress score and summed rest score; visually quantified TPD was given by summed stress score/(maximal score of 68) and summed rest score/68. The magnitude of perfusion abnormality on CT-MPI in regions of the myocardium was defined. Results: On a per-segment basis, there was good agreement between CT-MPI and SPECT-MPI with a kappa of 0.71 (p < 0.0001) for detection of stress perfusion abnormalities. Automated TPD on SPECT-MPI was similar to visual TPD from CT-MPI (p = 0.65 stress TPD, and p = 0.12 ischemic TPD stress-rest) with excellent agreement (bias = −0.3 for stress TPD, and bias = 1.2 for ischemic TPD) on Bland-Altman analysis. Software-based quantification of the magnitude of stress perfusion deficit and ischemia on CT-MPI were similar to that for automated TPD measured by SPECT (p = 0.88 stress, and p = 0.48 ischemia), with minimal bias (bias = 0.6, and bias = 1.2). Conclusions: Stress and reversible myocardial perfusion deficit measured by CT-MPI using a visual semiquantitative approach and a visually guided software-based approach show strong similarity with SPECT-MPI, suggesting that CT-MPI–based assessment of myocardial perfusion defects may be of clinical and prognostic value.

Original languageEnglish
Pages (from-to)1010-1019
Number of pages10
JournalJACC: Cardiovascular Imaging
Issue number10
StatePublished - Oct 2010
Externally publishedYes


FundersFunder number
Astellas Pharma US11143, IRB 145625
Lincy Foundation


    • computed tomography
    • ischemia
    • myocardial perfusion imaging
    • single photon emission computed tomography


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