Myocardial perfusion imaging using computed tomography: Current status, clinical value and prognostic implications

Abstract

Combined anatomical and functional evaluation of coronary artery disease (CAD) using computed tomography (CT) has recently emerged as an accurate, robust and non-invasive tool for the evaluation of ischemic heart disease. Cardiac CT has become a one-stop-shop imaging modality that allows the simultaneous depiction, characterization and quantification of coronary atherosclerosis and the assessment of myocardial ischemia. Advancements in scanner technology (improvements in spatial and temporal resolution, dual-energy imaging, wide detector panels) and the implementation of iterative reconstruction algorithms enables the detection of myocardial ischemia in both qualitative and quantitative fashion using low-dose scanning protocols. The addition of CT perfusion (CTP) to standard coronary CT angiography is a reliable tool to improve diagnostic accuracy. CTP using static first-pass imaging enables qualitative assessment of the myocardial tissue, whereas dynamic perfusion imaging can also provide quantitative information on myocardial blood flow. Myocardial tissue assessment by CTP holds the potential to refine risk in stable chest pain or microvascular dysfunction. CTP can aid the detection of residual ischemia after coronary intervention. Comprehensive evaluation of CAD using CTP might therefore improve the selection of patients for aggressive secondary prevention therapy or coronary revascularization with high diagnostic certainty. In addition, prognostic information provided by perfusion CT imaging could improve patient outcomes by quantifying the ischemic burden of the left ventricle. The current review focuses on the clinical value of myocardial perfusion imaging by CT, current status of CTP imaging and the use of myocardial CTP in various patient populations for the diagnosis of ischemic heart disease.

Dynamic Perfusion Computed Tomography for the Assessment of Concomitant Coronary Artery Disease in Patients with a History of Percutaneous Transluminal Angioplasty for Chronic Limb-Threatening Ischemia—A Pilot Study

“…In cases of CACS > 400, a dynamic myocardial perfusion CT scan (DPCT) was performed [20]. For hyperemia induction, a single 400 µg intravenous dose of regadenoson (Rapiscan ® , GE Healthcare, Chicago, IL, USA) was administered [21].…”

“…Coronary lesions were assigned to the corresponding myocardial segments based on the modified method after Cerci et al in the CORE320 (Coronary Artery Evaluation Using 320-Row Multidetector CTA) trial [25]. Vessel-based analysis for the alignment of myocardial territories and supplying large coronary vessels (left (LM), left anterior descending artery (LAD), left circumflex artery (LCX), and right coronary artery (RCA)) was performed by B.S., an expert with 10 years of experience in cardiac imaging [20].…”