Dynamic Myocardial CT Perfusion Imaging for Evaluation of Myocardial Ischemia as Determined by MR Imaging

Abstract

Compared with CMR, dynamic stress CT provides good diagnostic accuracy for the detection of myocardial perfusion defects and may differentiate ischemic and infarcted myocardium.

Direct myocardial ischemia imaging with exercise 18FDG

“…5,6 Although all of these imaging modalities have succeeded to some extent in developing techniques for MPI, yet these techniques remain somewhat cumbersome, complicated, technically challenging, limited only to very carefully selected patient populations and are far from being ready for routine clinical use. But most importantly, none of these techniques are currently able or likely to overcome the limitations of scintigraphic MPI.…”

On the use of computed tomography in cardiac imaging

“…At a later stage, the vendor made available a prototype software with this functionality, which greatly simplified the process. Thus, our focus was different to that of most other studies comparing dynamic CTP with SPECT or cMR, as the most common approach is that of visual detection of perfusion defects (58)(59)(60). However, a study by Wang et al (103) did a similar type of comparison albeit with a different patient group.…”

“…With dynamic CTP, myocardial perfusion is visualised through repeated imaging during the first pass contrast inflow in the myocardium. The change in myocardial attenuation during this period is detected and forms the basis for a quantitative estimation of myocardial blood flow (57)(58)(59)(60)(61). There are a number of critical pre-requisites for this approach: the scanning of the left ventricle must be fast to be able to detect the short-lived phase of increase in attenuation that comes with the wash-in of contrast, and the x-ray detector has to be large enough to allow coverage of the entire heart.…”

“…Most other comparative studies (58)(59)(60)103) have used a qualitative approach, with focus on the visual detection of perfusion defects as compared to the reference method. The results of these studies have also been more encouraging, with sensitivity and specificity for perfusion defects in relation to SPECT of 0.83-0.85 and 0.78-0.92 respectively (58,103).…”

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

“…In humans, quantitative dynamic CTP has shown to improve the overall diagnostic accuracy of coronary CTA in term of specificity and PPV (62,63), especially for interpretation of intermediate coronary lesions (30-70% luminal stenosis) compared with the reference standard of FFR (62).…”