ArticleJournal of nuclear cardiology : official publication of the American Society of Nuclear Cardiology2025
Integrating perfusion with AI-derived coronary calcium on CT attenuation scans to improve selection of low-risk studies for stress-only SPECT myocardial perfusion imaging.
Article in Journal of nuclear cardiology : official publication of the American Society of Nuclear Cardiology, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundIn many contemporary laboratories, a completely normal stress perfusion single-photon emission computed tomography myocardial perfusion imaging (SPECT-MPI) is required for rest imaging cancelation. We hypothesized that an artificial intelligence (AI)-derived coronary artery calcium (CAC) score of 0 from computed tomography attenuation correction (CTAC) scans obtained during hybrid SPECT/CT may identify additional patients at a low risk of major adverse cardiovascular events (MACEs) who could be selected for stress-only imaging.
methodsPatients without known coronary artery disease who underwent SPECT/CT MPI and had stress total perfusion deficit (TPD) <5% were included. Stress TPD was categorized as no abnormality (stress TPD: 0%) or minimal abnormality (stress TPD: 1%-4%). CAC was automatically quantified from the CTAC scans. We evaluated associations with MACEs.
resultsIn total, 6884 patients (49.4% males and median age: 63 years) were included. Of these, 9.7% experienced MACE (15% non-fatal myocardial infarction, 2.7% unstable angina, 38.5% coronary revascularization and 43.8% deaths). Compared to patients with TPD 0%, those with TPD 1%-4% and CAC 0 had lower MACE risk (hazard ratio [HR]: 0.58; 95% confidence interval [CI]: 0.45-0.76), while those with TPD 1%%-4% and CAC score>0 had a higher MACE risk (HR: 1.90; 95% CI: 1.56-2.30). Compared to canceling rest scans only in patients with normal perfusion (TPD 0%), by canceling rest scans in patients with CAC 0, more than twice as many rest scans (55% vs 25%) could potentially be canceled.
conclusionUsing an AI-derived CAC of 0 on CT scans with hybrid SPECT/CT in patients with a stress TPD <5% can double the proportion of patients in whom stress-only procedures could be safely performed.
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