Diagnostic Myocardial Perfusion Imaging to Detect the Anatomical Location of Coronary Artery Disease Compared With Invasive Coronary Angiography

Background: Although invasive coronary angiography (CAG) is the gold standard for the diagnosis of coronary artery disease (CAD), myocardial perfusion imaging (MPI) is also used in suspected cases. In this study, we sought to determine the diagnostic value of MPI in the anatomical localization of CAD. Methods: In a retrospective study, all patients with an intermediate to high probability of CAD who had positive single-photon emission computed tomography MPI and subsequently underwent CAG between January 2016 and January 2017 were evaluated. Results: A total of 210 patients at a mean age of 60.2±10.6 years underwent MPI and CAG. Abnormal anterior segments in MPI had a positive predictive value (PPV) of 68.1% to detect a diseased left anterior descending artery (LAD), and the negative predictive value (NPV) of similar segments for a concomitant LAD and right coronary artery (RCA) involvement was the highest (90.4%). Abnormal inferior segments in MPI had PPVs of 65.1% and 47% for the LAD and the RCA, respectively. The NPV was 81.8% for a concomitant LAD and RCA involvement and it was greater than either of each alone. Among the patients with abnormal posterior segments, the RCA and the left circumflex artery (LCX) had a PPV of 66.7%, which was greater than that of a concomitant RCA and LCX involvement. The NPV for either RAC or LCX alone or both arteries together was similar. Conclusions: MPI provides a relatively good diagnostic accuracy to detect abnormal segments matched to the involved coronary arteries in CAG. However, diagnostic accuracy was more pronounced in matching single-vessel CAD compared with double-vessel CAD.