A randomized, multicenter, multivendor study of myocardial perfusion imaging with regadenoson CT perfusion vs single photon emission CT.
BACKGROUND
Myocardial CT perfusion (CTP) is a promising tool for the detection of myocardial ischemia. We hypothesize that regadenoson CTP is noninferior to regadenoson single photon emission CT (SPECT) for detecting or excluding myocardial ischemia.


METHODS
Patients (men ≥ 45 years; women ≥ 50 years) with known or suspected coronary artery disease (n = 124) were randomized to 1 of 2 diagnostic sequences: rest and regadenoson SPECT on day 1, then regadenoson CTP and rest CTP (and coronary CT angiography [CTA]) (CTA; same acquisition) on day 2 or regadenoson CTP and rest CTP (and CTA) on Day 1, then rest and regadenoson SPECT on day 2. Scanning platforms included 64-, 128-, 256-, and 320-slice systems. The primary analysis examined the agreement rate between CTP and SPECT for detecting or excluding reversible ischemia in ≥ 2 myocardial segments as assessed by independent, blinded readers.


RESULTS
Complete and interpretable CTP and SPECT scans were obtained for 110 patients. Regadenoson CTP was noninferior to SPECT for detecting or excluding reversible ischemia with an agreement rate of 0.87 (95% confidence interval [CI], 0.77-0.97) and sensitivity and specificity of 0.90 (95% CI, 0.71-1.00) and 0.84 (95% CI, 0.77-0.91), respectively. The agreement rate for detecting or excluding ≥ 1 fixed defects by regadenoson CTP and SPECT was 0.86 (95% CI, 0.74-0.98). With SPECT as the reference standard, the diagnostic accuracies for detecting or excluding ischemia by regadenoson CTP and CTA alone were 0.85 (95% CI, 0.78-0.91) and 0.69 (95% CI, 0.60-0.77), respectively.


CONCLUSIONS
This study establishes the noninferiority of regadenoson CTP to SPECT for detecting or excluding myocardial ischemia.
['Cury|Ricardo C|RC|', 'Kitt|Therese M|TM|', 'Feaheny|Kathleen|K|', 'Blankstein|Ron|R|', 'Ghoshhajra|Brian B|BB|', 'Budoff|Matthew J|MJ|', 'Leipsic|Jonathon|J|', 'Min|James K|JK|', 'Akin|Jamie|J|', 'George|Richard T|RT|']
D000368:Aged D016001:Confidence Intervals D017023:Coronary Angiography D023921:Coronary Stenosis D005260:Female D006801:Humans D008297:Male D008875:Middle Aged D009203:Myocardial Infarction D017202:Myocardial Ischemia D055414:Myocardial Perfusion Imaging D015588:Observer Variation D011687:Purines D011720:Pyrazoles D012680:Sensitivity and Specificity D015899:Tomography, Emission-Computed, Single-Photon D014057:Tomography, X-Ray Computed
Regadenoson CT perfusion Single photon emission CT Myocardial ischemia