Non-invasive detection of coronary artery stenosis: a comparison among power-Doppler contrast echo, 99Tc-Sestamibi SPECT and echo wall-motion analysis

Coron Artery Dis. 2003 May;14(3):239-45. doi: 10.1097/01.mca.0000065924.30342.38.


Background: Power-Doppler imaging is a recently developed method for myocardial contrast echocardiography (MCE). It can selectively evaluate the signal coming from an ultrasound contrast agent, allowing myocardial perfusion studies.

Objective: To compare the ability of power-Doppler MCE with stress-echo wall-motion and nuclear scan imaging (SPECT) to assess myocardial ischaemia during pharmacological stress, using coronary angiography as reference.

Methods: In 25 patients the three non-invasive imaging modalities were acquired during a single dipyridamole stress test (so as to avoid stress variations). Power-Doppler MCE was acquired using continuous intravenous infusion of Levovist. Echo wall-motion was acquired too. At peak stress 99Tc-Sestamibi was injected; stress SPECT images were acquired 30 min after injection.

Results: Power-Doppler MCE and SPECT showed 84% concordance (21 of 25 patients; kappa=0.67) for detection of ischaemia. Concordance based on coronary artery territories for normal perfusion versus fixed defects versus reversible defects was 92% (69 of 75; kappa=0.81), with 100% for left anterior descending, 92% for right coronary artery and 84% for circumflex. Power-Doppler MCE had lower sensitivity than SPECT (89 versus 100%) but higher specificity (100 versus 88%) for identification of stenotic (> or = 70%) coronary arteries as assessed by angiography. Echo wall-motion analysis showed the lowest sensitivity (68%) with 100% specificity. Accuracy was 94% for both power-Doppler MCE and SPECT, and 83% for wall-motion analysis.

Conclusion: Power-Doppler MCE is a sensitive and specific method for identification of myocardial perfusion during pharmacological stress. Accuracy of power-Doppler MCE for stenotic coronary arteries appears to be slightly higher than stress-echo wall-motion and similar to SPECT.

Publication types

  • Comparative Study

MeSH terms

  • Aged
  • Arteries / diagnostic imaging
  • Arteries / pathology
  • Coronary Angiography
  • Coronary Artery Disease / diagnosis
  • Coronary Artery Disease / epidemiology
  • Coronary Stenosis / diagnosis*
  • Coronary Stenosis / epidemiology
  • Coronary Vessels / diagnostic imaging
  • Coronary Vessels / pathology
  • Echocardiography*
  • Echocardiography, Doppler
  • Exercise Test
  • Female
  • Humans
  • Male
  • Middle Aged
  • Myocardial Reperfusion
  • Observer Variation
  • Radiopharmaceuticals*
  • Sensitivity and Specificity
  • Technetium Tc 99m Sestamibi*
  • Tomography, Emission-Computed, Single-Photon*


  • Radiopharmaceuticals
  • Technetium Tc 99m Sestamibi