Diagnostic and clinical benefit of combined coronary calcium and perfusion assessment in patients undergoing PET/CT myocardial perfusion stress imaging

J Nucl Cardiol. 2010 Apr;17(2):188-96. doi: 10.1007/s12350-009-9159-9. Epub 2009 Dec 11.


Background: A limitation of stress myocardial perfusion imaging (MPI) is the inability to detect non-obstructive coronary artery disease (CAD). One advantage of MPI with a hybrid CT device is the ability to obtain same-setting measurement of the coronary artery calcium score (CACS).

Methods and results: Utilizing our single-center nuclear database, we identified 760 consecutive patients with: (1) no CAD history; (2) a normal clinically indicated Rb-82 PET/CT stress perfusion study; and (3) a same-setting CAC scan. 487 of 760 patients (64.1%) had subclinical CAD based on an abnormal CACS. Of those with CAC, the CACS was > or =100, > or =400, and > or =1000 in 47.0%, 22.4%, and 8.4% of patients, respectively. Less than half of the patients with CAC were receiving aspirin or statin medications prior to PET/CT imaging. Patients with CAC were more likely to be initiated or optimized on proven medical therapy for CAD immediately following PET/CT MPI compared to those without CAC.

Conclusions: Subclinical CAD is common in patients without known CAD and normal myocardial perfusion assessed by hybrid PET/CT imaging. Identification of CAC influences subsequent physician prescribing patterns such that those with CAC are more likely to be treated with proven medical therapy for the treatment of CAD.

MeSH terms

  • Aged
  • Atherosclerosis / pathology
  • Calcium / metabolism*
  • Computer Simulation
  • Coronary Vessels / pathology
  • Female
  • Heart / diagnostic imaging*
  • Heart / physiology
  • Humans
  • Male
  • Middle Aged
  • Myocardium / metabolism*
  • Myocardium / pathology
  • Perfusion
  • Positron-Emission Tomography / methods*
  • Prognosis
  • Risk Factors
  • Tomography, X-Ray Computed / methods*


  • Calcium