Is the diagnostic performance of stress myocardial computed tomographic perfusion comparable with other established myocardial perfusion imaging techniques? A systematic review.

Abstract

Objectives This systematic review assessed the diagnostic performance of stress computed tomography perfusion (CTP) imaging in detecting myocardial ischemia caused by coronary artery disease as compared with clinical reference standards. Additionally, the diagnostic performance of myocardial CTP imaging techniques (static and dynamic) and the use of dual-energy computed tomography acquisition in static CTP were assessed.

Methods

The Web of Science and PubMed databases were searched from January 2009 to June 2019 for articles that met the inclusion criteria. A quality assessment of the selected studies was performed using the QUADAS-2 tool. Studies reporting diagnostic measures were included in the meta-analysis. For those studies, the diagnostic performance measures (i.e., sensitivity, specificity, positive and negative predictive values, and the area under curve) were pooled according to reference standard, level of analysis, and stress CTP techniques, with at least four studies included in each group using a univariate random-effects model.

Results

A total of 28 of 2,778 reviewed articles met the inclusion criteria of this systematic review. Of those 28 studies, 21 eligible studies were identified and included in the meta-analysis. The diagnostic performance of stress myocardial CTP against various reference standards showed high values of sensitivity and specificity at different levels. Additionally, comparing stress CTP techniques revealed no differences in their diagnostic performance in detecting myocardial ischemia. Further, static stress CTP studies performed using the dual-energy acquisition mode presented high sensitivity and specificity at the segment level.

Conclusions Stress CTP demonstrates high diagnostic performance in detecting myocardial ischemia when compared with other established reference tools.