Myocardial perfusion imaging using adenosine-induced stress dual-energy computed tomography of the heart: comparison with cardiac magnetic resonance imaging and conventional coronary angiography

Ko, Sung Min; Choi, Jin Woo; Song, Meong Gun; Shin, Jong-chil; Chee, Hyun Kun; Chung, Hyun Woo; Kim, Dong Hun

doi:10.1007/s00330-010-1897-1

Cited by 153 publications

(102 citation statements)

References 29 publications

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“…Dual-energy CT technology may provide image acquisition using more than a single energy X-ray spectrum (30,31). Dual-energy CT represents a promising technique for the integrative analysis of coronary artery morphology and myocardial blood supply; furthermore Dual-energy CT is in good agreement with invasive coronary angiography and SPECT (30).…”

Section: Ct Technical Notesmentioning

confidence: 99%

“…It is well known that stress perfusion abnormalities occur before wall motion dysfunction (50). Therefore, additional scans acquired during pharmacologic stress with adenosine or dipyridamole may detect reversible perfusion defects of myocardium (31,(51)(52)(53). Therefore, the stress-CCT may be indicated: in symptomatic patients at intermediate risk of …”

Section: Ct Technical Notesmentioning

confidence: 99%

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Infarct characterization using CT

Grutta

Toia

Maffei

et al. 2017

Cardiovasc. Diagn. Ther.

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Myocardial infarction (MI) is a major cause of death and disability worldwide. The incidence is not expected to diminish, despite better prevention, diagnosis and treatment, because of the ageing population in industrialized countries and unhealthy lifestyles in developing countries. Nowadays it is highly requested an imaging tool able to evaluate MI and viability. Technology improvements determined an expansion of clinical indications from coronary plaque evaluation to functional applications (perfusion, ischemia and viability after MI) integrating additional phases and information in the mainstream examination.Cardiac computed tomography (CCT) and cardiac MR (CMR) employ different contrast media, but may characterize MI with overlapping imaging findings due to the similar kinetics and tissue distribution of gadolinium and iodinated contrast media. CCT may detect first-pass perfusion defects, dynamic perfusion after pharmacological stress, and delayed enhancement (DE) of non-viable territories.

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Section: Ct Technical Notesmentioning

confidence: 99%

Section: Ct Technical Notesmentioning

confidence: 99%

Infarct characterization using CT

Grutta

Toia

Maffei

et al. 2017

Cardiovasc. Diagn. Ther.

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“…Based on the specific absorption characteristics of iodine for different X-ray energies, DECT allows mapping of intra-myocardial iodine extent and distribution, and small sample studies have demonstrated the feasibility of this technique to detect myocardial perfusion deficits [15][16][17]. However, large-scale studies examining stress DECT-MPI are lacking [18,19]. Furthermore, the diagnostic performance of combined CCTA and stress DECT-MPI compared with CCTA, based on a combined anatomicalphysiological reference standard, has not been performed.…”

Section: Introductionmentioning

confidence: 99%

Stress Dual-Energy Computed Tomography-Myocardial Perfusion Imaging to Identify Coronary Artery Stenoses Causing Ischemia: A Direct Comparison between Invasive Coronary Angiography and Cardiac Magnetic Resonance-Myocardial Perfusion Imaging

Song

Hwang

et al. 2017

Cardiovasc Imaging Asia

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Objective:We determined the diagnostic performance of stress dual-energy computed tomography-myocardial perfusion imaging (DECT-MPI) for diagnosing coronary artery stenoses causing ischemia. Materials and Methods:Institutional review board approval and informed patient consent were obtained before patient enrollment in the study. One hundred ninety-two consecutive patients (135 males, 63.1±8.0 years) underwent coronary computed tomography angiography (CCTA), stress DECT-MPI, and a combined invasive coronary angiography (ICA)/cardiac magnetic resonance-myocardial perfusion imaging (CMR-MPI) for further comparison. Stress DECT-MPI and CMR-MPI were evaluated for perfusion deficits, whereas CCTA and ICA were evaluated for coronary stenosis ≥50%. The primary endpoint was the diagnostic performance of combined CCTA/stress DECT-MPI compared with combined ICA/CMR-MPI at the per-vessel level. Individual direct comparisons of CCTA to ICA and stress DECT-MPI to CMR-MPI were explored. Results:One hundred forty-four (75%) patients and 257 (45%) vascular territories manifested ischemia-causing coronary stenoses based on combined ICA/CMR-MPI. Per-vessel sensitivity, specificity, positive predictive value, and negative predictive value of combined CCTA/stress DECT-MPI were 88, 82, 79, and 89%, respectively, compared with combined ICA/ CMR-MPI. The values for CCTA alone were 95, 45, 63, and 94%, respectively, and the values for stress DECT-MPI alone were 91, 75, 75, and 92%, respectively. The area under the receiver operating characteristics curve for combined CCTA/stress DECT-MPI was higher than that for CCTA alone (0.85 vs. 0.75, p=0.001). Conclusion:When compared with combined ICA/CMR-MPI, combined CCTA/stress DECT-MPI improved the predictive value for coronary stenoses causing ischemia compared with CCTA, but only mildly improved the diagnostic performance of stress DECT-MPI alone.

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“…Recently, a paper was published in European Radiology by Ko et al [15], which compared adenosine stress perfusion dual-energy CT and CTA of the coronary arteries with stress-perfusion MRI and conventional coronary angiography; they showed that adenosine-stress dualenergy-CT can identify perfusion defects with a sensitivity, specificity and accuracy of 89%, 78%, and 82%, respectively. But, at the moment, the radiation dose from such combined protocols is still too high to use in the daily clinical routine.…”

mentioning

confidence: 99%

“…Adenosine stress-perfusion imaging [11][12][13][14][15] is feasible and several studies show promising results. The clear advantage of CT in this setting is the complementary evaluation of coronary artery anatomy and myocardial function, which overcomes current shortcomings of CTA.…”

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confidence: 99%

Commentary on: delayed enhancement imaging of myocardial viability: low-dose high-pitch CT versus MRI

Wolf

2011

Eur Radiol

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In 2005, Nikolaou et al.[1] published a paper in European Radiology about the assessment of myocardial perfusion and viability from routine contrast-enhanced 16-detectorrow computed tomography. The authors reported promising results, however, concluded carefully: "… application of delayed enhancement techniques might be useful. … However, this procedure requires a second delayed CT scan, increasing the radiation exposure of the patient."I remember the first scientific presentations about cardiac perfusion imaging and delayed enhancement using computed tomography-it was interesting, but the scientific community considered this topic more or less a scientific gimmick rather than serious work with clinical relevance. Now, in 2011, Alkadhi et al.[2] publish in European Radiology a paper entitled "Delayed enhancement imaging of myocardial viability: Low-dose high-pitch CT versus MRI." The authors included 24 patients and could show that by using the newest generation CT equipment, delayed enhancement by CT has become a reality at a ultra-low radiation dose in submillisievert range, and is now ready for clinical use: The estimated mean radiation dose was as low as 0.89±0.07 mSv (range: 0.74-1.02 mSv). This low radiation dose was obtained by using the "high-pitch" spiral CT technique with a pitch factor of 3.4 and prospective ECG-synchronization; furthermore a 100 kV tube voltage was applied for the delayed enhancement CT data acquisition, making use of the higher attenuation of iodine at lower photon energies. In the present study, the authors perform a standard contrast-enhanced CTA using a high-pitch protocol on a commercially available 128-slice, dual-source CT system after the administration of 70 ml iodinated contrast media. In order to achieve an adequate dose of iodine, 5 min after the first CT data-acquisition, a second dose of 70 ml of iodinated contrast media was administered and, after a total delay of around 15 min from the first injection, a second high-pitch delayed enhancement CT data-set was obtained. The sensitivity, specificity, and accuracy of CT for the diagnosis of non-viability were 90.0%, 92.9%, and 91.7% per patient and 60.7%, 96.8% and 94.4% per segment, respectively, with MRI serving as the gold standard.What happened in the last 6 years to make the vision of myocardial viability imaging a reality?In my opinion, new technical developments such as lowdose gating techniques, prospective ECG-triggering and high-pitch CT are all responsible for this present step forward in cardiac imaging. The Cardiac Imaging 'hype' started with the introduction of 64-slice CT with a revolution in image quality. This first wave of excitement was followed by a disillusion: the radiation dose of cardiac CT reached values of 12-14 mSv, even higher than the radiation dose values of a conventional invasive angiography. However with the introduction of newer CT equipment with 128-, 256-, and 320-slices, as well as dual source CT-machines, faster CT protocols with radically lower radiation dose have become possible. In ...

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Myocardial perfusion imaging using adenosine-induced stress dual-energy computed tomography of the heart: comparison with cardiac magnetic resonance imaging and conventional coronary angiography

Abstract: Adenosine stress DECT can identify stress-induced myocardial PD in patients with CAD.

Cited by 153 publications

References 29 publications

Infarct characterization using CT

Infarct characterization using CT

Stress Dual-Energy Computed Tomography-Myocardial Perfusion Imaging to Identify Coronary Artery Stenoses Causing Ischemia: A Direct Comparison between Invasive Coronary Angiography and Cardiac Magnetic Resonance-Myocardial Perfusion Imaging

Commentary on: delayed enhancement imaging of myocardial viability: low-dose high-pitch CT versus MRI

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