Diagnostic Performance of Combined Noninvasive Anatomic and Functional Assessment With Dual-Source CT and Adenosine-Induced Stress Dual-Energy CT for Detection of Significant Coronary Stenosis

Ko, Sung Min; Choi, Jin Woo; Hwang, Hweung Kon; Song, Meong Gun; Shin, Jong-chil; Chee, Hyun Keun

doi:10.2214/ajr.11.7029

Cited by 103 publications

(56 citation statements)

References 33 publications

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“…Different vendors have re-introduced DECT and in recent years the technique has become clinically feasible. The DECT acquisition may be performed using a DSCT with two tubes simultaneously emitting higher (140-150 kV) and lower (80-90-100 kV) energy levels (35)(36)(37). A second approach consists of a single-source CT scanner with rapid kV switching (from 80 to 140 kV) to acquire the dualenergy samples almost simultaneously either in a single gantry rotation (GSI Cardiac; GE Healthcare), or in consecutive rotations (Acquilion One; Toshiba) (12,16,34).…”

Section: Static Ctp Imaging-dual-energy Ct Acquisitionmentioning

confidence: 99%

Myocardial blood flow quantification for evaluation of coronary artery disease by computed tomography

Cademartiri

Seitun

Clemente

et al. 2017

Cardiovasc. Diagn. Ther.

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During the last decade coronary computed tomography angiography (CTA) has become the preeminent noninvasive imaging modality to detect coronary artery disease (CAD) with high accuracy.However, CTA has a limited value in assessing the hemodynamic significance of a given stenosis due to a modest specificity and positive predictive value. In recent years, different CT techniques for detecting myocardial ischemia have emerged, such as CT-derived fractional flow reserve (FFR-CT), transluminal attenuation gradient (TAG), and myocardial CT perfusion (CTP) imaging. Myocardial CTP imaging can be performed with a single static scan during first pass of the contrast agent, with monoenergetic or dualenergy acquisition, or as a dynamic, time-resolved scan during stress by using coronary vasodilator agents (adenosine, dipyridamole, or regadenoson). A number of CTP techniques are available, which can assess myocardial perfusion in both a qualitative, semi-quantitative or quantitative manner. Once used primarily as research tools, these modalities are increasingly being used in routine clinical practice. All these techniques offer the substantial advantage of combining anatomical and functional evaluation of flow-limiting coronary stenosis in the same examination that would be beneficial for clinical decision-making. This review focuses on the state-of the-art and future trends of these evolving imaging modalities in the field of cardiology for the physiologic assessments of CAD.

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Section: Static Ctp Imaging-dual-energy Ct Acquisitionmentioning

confidence: 99%

Myocardial blood flow quantification for evaluation of coronary artery disease by computed tomography

Cademartiri

Seitun

Clemente

et al. 2017

Cardiovasc. Diagn. Ther.

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“…In two studies in 45 and 35 angina patients, respectively, MPI-CT combined with CTCA had a PPV of 88 % and 86 % and an NPV of 91 % and 93 %, respectively, in a per-vessel analysis for the detection of≥ 50 % stenosis on ICA [48,49]. In 42 patients with at least 1≥50 % angiographic stenosis on ICA, MPI-CT combined with CTCA was compared with invasive FFR by Ko et al [50].…”

Section: Combining Anatomy and Functionmentioning

confidence: 99%

CT fractional flow reserve: the next level in non-invasive cardiac imaging

2012

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The haemodynamic effect of a coronary artery stenosis is a better predictor of prognosis than anatomical lumen obstruction. Until recently, no individual noninvasive test could provide both accurate coronary anatomy and lesion-specific myocardial ischaemia. However, computer tomography (CT) fractional flow reserve, which can be calculated from a standard CT coronary angiogram, was recently demonstrated to accurately detect and rule out the haemodynamic significance of individual coronary artery stenoses.

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“…Diagnostic accuracy was found to be comparable to that of SPECT. Ko et al 93 reported increases in sensitivity, specificity, PPV, and NPV from 91.8%, 67.7%, 73.6% and 87.5% to 93.2%, 85.5%, 88.3% and 91.4%, respectively, by adding DE FP CT to DE CTA (Figure 4). …”

mentioning

confidence: 98%

Cardiac CT for myocardial ischaemia detection and characterization—comparative analysis

Bucher¹,

Cecco²,

Schoepf³

et al. 2014

BJR

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The assessment of patients presenting with symptoms of myocardial ischaemia remains one of the most common and challenging clinical scenarios faced by physicians. Current imaging modalities are capable of three-dimensional, functional and anatomical views of the heart and as such offer a unique contribution to understanding and managing the pathology involved. Evidence has accumulated that visual anatomical coronary evaluation does not adequately predict haemodynamic relevance and should be complemented by physiological evaluation, highlighting the importance of functional assessment. Technical advances in CT technology over the past decade have progressively moved cardiac CT imaging into the clinical workflow. In addition to anatomical evaluation, cardiac CT is capable of providing myocardial perfusion parameters. A variety of CT techniques can be used to assess the myocardial perfusion. The single energy firstpass CT and dual energy first-pass CT allow static assessment of myocardial blood pool. Dynamic cardiac CT imaging allows quantification of myocardial perfusion through time-resolved attenuation data. CT-based myocardial perfusion imaging (MPI) is showing promising diagnostic accuracy compared with the current reference modalities. The aim of this review is to present currently available myocardial perfusion techniques with a focus on CT imaging in light of recent clinical investigations. This article provides a comprehensive overview of currently available CT approaches of static and dynamic MPI and presents the results of corresponding clinical trials.

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Diagnostic Performance of Combined Noninvasive Anatomic and Functional Assessment With Dual-Source CT and Adenosine-Induced Stress Dual-Energy CT for Detection of Significant Coronary Stenosis

Abstract: Combined dual-source coronary CTA and CT MPI provides incremental diagnostic value compared with dual-source coronary CTA alone for the detection of significant coronary stenoses.

Cited by 103 publications

References 33 publications

Myocardial blood flow quantification for evaluation of coronary artery disease by computed tomography

Myocardial blood flow quantification for evaluation of coronary artery disease by computed tomography

CT fractional flow reserve: the next level in non-invasive cardiac imaging

Cardiac CT for myocardial ischaemia detection and characterization—comparative analysis

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