Integrating Perfusion with AI-derived Coronary Calcium on CT attenuation scans to improve selection of low-risk studies for stress-only SPECT MPI

作者：Robert J. H. Miller, Orit Barrett, Aakash D. Shanbhag, Alan Rozanski, Damini Dey, M. Lemley, S. V. Van Kriekinge, P. Kavanagh, Attila Feher, E. J. Miller, Andrew J. Einstein, Terrence D. Ruddy, T. Bateman, Philipp A. Kaufmann, Joanna X. Liang, Daniel S. Berman, Piotr J. Slomka · 发表于：Journal of Nuclear Cardiology · 年份：2025 · DOI：10.1016/j.nuclcard.2025.102482 · 研究领域：Medicine

Background. In many contemporary laboratories a completely normal stress perfusion SPECT-MPI is required for rest imaging cancelation. We hypothesized that an artificial intelligence (AI)-derived CAC score of 0 from computed tomography attenuation correction (CTAC) scans obtained during hybrid SPECT/CT, may identify additional patients at low risk of MACE who could be selected for stress-only imaging. Methods and Results. Patients 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 major adverse cardiovascular events (MACE). In total, 6,884 patients (49.4% males and median age 63 years) were included. Of these, 9.7% experienced MACE (15% non-fatal MI, 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 be cancelled. Conclusion. Using AI-derived CAC 0 on CT scans with hybrid S...