“In patients with multiple lesions or complex coronary anatomy, it is, in many cases, very difficult to correctly identify the culprit lesion,” he said. “In a previous multicenter trial, with hybrid imaging we were able to see that about one in five patients should be revascularized in another coronary artery than originally planned. The present study now documents the prognostic importance of the comprehensive assessment provided by hybrid imaging.”
The study supports CCTA use for an initial, noninvasive evaluation of patients with known or suspected stable coronary artery disease. No additional imaging would be necessary if the results were normal. If a lesion was evident, then clinicians could employ a nuclear scan to assess ischemia and take advantage of both modalities by fusing the results together to make a hybrid image.
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“The strategy of direct referral to invasive coronary angiography without noninvasive imaging is obsolete,” Dr. Kaufmann said. “Even after documenting coronary artery disease with coronary CT angiography, we need further noninvasive evaluation before deciding upon revascularization versus medication.”
The researchers hope to run a trial to show that hybrid imaging can have a positive impact on patient outcomes. They are also looking at what they call “triple hybrid” imaging, which combines the CCTA/SPECT hybrid with information on coronary artery shear stress. The shear stress information could help identify lesions that do not yet have an impact on ischemia but will in the future.
“Hybrid SPECT Perfusion Imaging and Coronary CT Angiography: Long-Term Prognostic Value for Cardiovascular Outcomes.” Collaborating with Dr. Kaufmann were Aju P. Pazhenkottil, M.D., Dominik C. Benz, M.D., Christoph Gräni, M.D., Michael A. Madsen, M.D., Fran Mikulicic, M.D., Elia von Felten, M.D., Tobias A. Fuchs, M.D., Beatrice Hirt Moch, M.D., Julia Stehli, M.D., Thomas F. Lüscher, M.D., Oliver Gaemperli, M.D., and Ronny R. Buechel, M.D.
Radiology is edited by David A. Bluemke, M.D., Ph.D., University of Wisconsin School of Medicine and Public Health, Madison, Wis., and owned and published by the Radiological Society of North America, Inc.
RSNA is an association of over 54,200 radiologists, radiation oncologists, medical physicists and related scientists, promoting excellence in patient care and health care delivery through education, research and technologic innovation. The Society is based in Oak Brook, Ill.
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