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CC BY-NC-ND 4.0 · World J Nucl Med 2019; 18(02): 149-153
DOI: 10.4103/wjnm.wjnm_34_18
Original Article

Benefits of adding coronary calcium score scan to stress myocardial perfusion positron emission tomography imaging

Ahmed Fathala
1   Department of Radiology Nuclear Medicine and Cardiovascular Imaging, King Faisal Specialist Hospital and Research Centre, Riyadh
,
Mervat Aboulkheir
1   Department of Radiology Nuclear Medicine and Cardiovascular Imaging, King Faisal Specialist Hospital and Research Centre, Riyadh
2   Department of Radiology, Taibah University Madina
,
Salwa Bukhari
1   Department of Radiology Nuclear Medicine and Cardiovascular Imaging, King Faisal Specialist Hospital and Research Centre, Riyadh
,
Mohamed M Shoukri
3   Department of Cell Biology, Research Centre King Faisal Specialist Hospital and Research Centre Riyadh, Saudi Arabia
,
Moheieldin M Abouzied
1   Department of Radiology Nuclear Medicine and Cardiovascular Imaging, King Faisal Specialist Hospital and Research Centre, Riyadh
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Abstract

There have been little and conflicting data regarding the relationship between coronary artery calcification score (CACS) and myocardial ischemia on positron emission tomography myocardial perfusion imaging (PET MPI). The aims of this study were to investigate the relationship between myocardial ischemia on PET MPI and CACS, the frequency and severity of CACS in patients with normal PET MPI, and to determine the optimal CACS cutoff point for abnormal PET. This retrospective study included 363 patients who underwent same-setting stress PET perfusion imaging and CACS scan because of clinically suspected coronary artery disease (CAD). Fifty-five (55%) of the 363 patients had abnormal PET perfusion. There was an association between sex, diabetes mellitus (DM), smoking, and CACS and PET perfusion abnormities with P = 0.003, 0.05, 0.005, and 0.001, respectively. However, there was no association between PET perfusion abnormalities with age, body mass index, hypertension, and hypercholesterolemia. There was association between CACS and age, sex, and DM with P = 0.000, 0.014, and 0.052, respectively, and stepwise increase in the frequency of myocardial ischemia and CACS groups. Receiver-operating characteristic analysis showed that a CACS ≥304 is the optimal cutoff for predicting perfusion abnormalities with sensitivity of 64% and specificity of 69%. In conclusion, the frequency of CAC in patients with normal PET MPI is 49%, it is highly recommended to combine CACS with PET MPI in patients without a history of CAD. PET MPI identifies myocardial ischemia and defines the need for coronary revascularization, but CAC reflects the anatomic burden of coronary atherosclerosis. Combining CACS to PET MPI allows better risk stratification and identifies high-risk patients with PET, and it may change future follow-up recommendations. CACS scan is readily available and easily acquired with modern PET-computed tomography (CT) and single-photon emission CT (SPECT)-CT with modest radiation exposure.

Keywords

Coronary artery calcification score-coronary artery disease - myocardial ischemia - positron emission tomography myocardial perfusion - stress functional imaging

Financial support and sponsorship

Nil.




Publication History

Received: 00 00 2019

Accepted: 00 00 2019

Article published online:
22 April 2022

© 2019. Sociedade Brasileira de Neurocirurgia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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