Cardiac CT perfusion and FFRCTA: pathophysiological features in ischemic heart disease

Abstract

Cardiac computed tomography (CCT) has rapidly evolved, becoming a powerful integrated tool for the evaluation of coronary artery disease (CAD), and being superior to other noninvasive methods due to its high accuracy and ability to simultaneously assess both lumen stenosis and atherosclerotic plaque burden. Furthermore, CCT is regarded as an effective gatekeeper for coronary angiography, and carries independent important prognostic information. In the last decade, the introduction of new functional CCT applications, namely CCT perfusion (CCTP) imaging and CT-derived fractional flow reserve (FFR CTA ), has opened the door for accurate assessment of the haemodynamic significance of stenoses. These new CCT technologies, thus, share the unique advantage of assessing both myocardial ischemia and patient-specific coronary artery anatomy, providing an integrated anatomical/functional analysis. In the present review, starting from the pathophysiology of myocardial ischemia, we evaluate the existing evidence for functional CCT imaging and its value in relation to alternative, well-established, non-invasive imaging modalities and invasive indices of ischemia (currently the gold-standard). The knowledge of clinical applications, benefits, and limitations of these new CCT technologies will allow efficient and optimal use in clinical practice in the near future.

Current Status of Cardiovascular Imaging in Germany: Structured Data from the National Certification Program, ESCR Registry, and Survey among Radiologists

“…In terms of MRI, techniques such as T1 and T2 mapping are in the process of leaping from scientific application to clinical routine 16 17 , and new imaging acceleration techniques such as compressed sensing are showing their strengths in imaging a moving organ 18 . Considering CT, techniques such as myocardial CT perfusion and CT-derived fractional flow reserve promise to provide insight beyond simple anatomy imaging 19 20 . Here radiology has demonstrated its high innovation power regarding clinical and technical aspects, embracing new technology (e. g., artificial intelligence) whenever that benefits the patient.…”

Incremental value of volumetric quantification for myocardial perfusion imaging by computed tomography

“…Therefore, the VOI contours included the area within the myocardial wall with index-MBF <0.78. In the next step, the measured VOI of ischemia was divided by the automatically measured total VOI for the LV muscle (VOI of LV muscle, mm 3 ). An example is presented in Figure 1.…”

“…Our results underline the importance of ischemic volume quantification for the appropriate planning of interventional therapies in chronic coronary syndromes and allow for the identification of outpatients with a smaller ischemic area who may not benefit from revascularization. sion (CTP) have been increasingly tested for the assessment of the functional significance of coronary stenosis [3][4][5]. Despite the suggested equivalence of the diagnostic values of CT-FFR and dynamic CTP, however, both imaging modalities have unique advantages and disadvantages [3][4][5].…”

“…sion (CTP) have been increasingly tested for the assessment of the functional significance of coronary stenosis [3][4][5]. Despite the suggested equivalence of the diagnostic values of CT-FFR and dynamic CTP, however, both imaging modalities have unique advantages and disadvantages [3][4][5]. CT-FFR requires a high-quality CTA scan and preferably a lower calcium score, whereas dynamic CTP needs additional radiation but is more robust in patients with compromised quality coronary CTA or high calcium loads [4,5].…”

Perfusão miocárdica e reserva de fluxo fracionada por tomografia computadorizada e cintilografia em pacientes com isquemia pelo teste ergométrico

“…Nas diretrizes atuais, a Tomografia Computadorizada de coronárias, embora venha ganhando maior recomendação e nível de evidência, ainda apresenta limitações para avaliação de pacientes com dor torácica estável e com obstrução intermediária em vasos coronarianos 58,59,60 O método é definido pela razão da pressão distal do vaso (Pd) medida pelo cateter intravascular e a pressão proximal do mesmo vaso (Pp), ou aórtica em estado de hiperemia máxima, normalmente, alcançados com auxílio de medicamentos vasodilatadores, como a adenosina. Lesões coronárias com valores menores ou iguais a 0,80 são consideradas hemodinamicamente comprometidas 61 .…”