ontrast enhanced multislice spiral computed tomography (CE-MSCT) has been proposed as a means of evaluating coronary artery stenoses. [1][2][3] In just a few years, technological advances have progressively improved the temporal resolution. Recent studies showed that CE-MSCT allows for a noninvasive assessment of coronary artery disease (CAD) in a clinical setting. [4][5][6][7][8][9][10] In addition to coronary artery assessment, CE-MSCT can also provide information about myocardial perfusion. Koyama et al reported that CE-MSCT could describe acute myocardial infarction (AMI) as a perfusion defect after the injection of a bolus of contrast medium. 11 Their data showed myocardial viability and function after AMI.No attempt to detect myocardial ischemia using pharmacological stress MSCT has been reported previously. Adenosine triphosphate (ATP) is widely used as a coronary vasodilator to detect myocardial ischemia in the fields of magnetic resonance imaging, 12 nuclear imaging 13 and echocardiography. 14 We hypothesized that CE-MSCT can describe myocardial ischemia as a hypo-perfusion area (HPA) using the ATP provocation test. The present study was designed to: (i) to test our hypothesis; and (ii) to evaluate the potential of the ATP stress CE-MSCT in a clinical setting. Methods Study ProtocolThe study protocol necessitated that the enrolled patients underwent both ATP-provocation/non-provocation CE-MSCT and stress thallium-201 myocardial perfusion scintigraphy (MPS), and received conventional coronary angiography (CAG) as required. All patients gave their informed consent and the protocol was approved by the hospital's ethics committee.The entry criteria were as follows: (i) de novo effort or rest stable angina (documented ST-T change on electrcardiogram (ECG), or relieved by administration of nitroglycerin); (ii) no history of coronary angiography; and (iii) asymptomatic patients with a high probability of CAD (ie, multiple coronary risk factors) or abnormal findings in exercise ECG.The exclusion criteria included: (i) acute myocardial infarction (within 3 months); (ii) unstable angina (recent onset of angina within a month, severe and worsening clinical symptom); (iii) chronic atrial fibrillation; (iv) deteriorated renal function (serum creatinine >1.5 mg/dl); (v) pregnancy, hyperthyroidism or a known allergic reaction to Background The present study was designed to: (i) detect myocardial ischemia in contrast enhanced multislice spiral computed tomography (CE-MSCT) using adenosine triphosphate (ATP) pharmacological stress test; and (ii) evaluate the potential of ATP stress CE-MSCT in a clinical setting. Methods and ResultsTwelve patients underwent ATP stress CE-MSCT and stress thallium-201 myocardial perfusion scintigraphy (MPS) and 9 of the patients received conventional coronary angiography (CAG). Dual CE-MSCT scans were performed for stress and rest images, with and without intravenous infusion of ATP (0.16 mg·kg -1 ·min -1 ) at intervals of 20 min. Myocardial perfusion and coronary artery were visually eval...

oronary computed tomography angiography (CTA) can evaluate coronary artery stenosis, 1-6 and using the same raw data, cardiac function such as wall motion and systolic wall thickening (SWT) can be evaluated 7-11 when retrospective ECG-gating acquisition is used and multiple cardiac phases are reconstructed.Trials of image fusion between different modalities such as conventional coronary angiography (CAG) and myocardial perfusion scintigraphy (MPS) 12 have demonstrated the potential usefulness in clarifying the relationship betweena regional myocardial perfusion abnormality and the responsible coronary artery. However, image fusion of the coronary artery and functional map by multislice spiral computed tomography (MSCT) alone has not been elucidated yet.Because the organization of a series of clinical findings from cardiac imaging modalities is necessary for intelligible expression in the clinical setting, we considered that the 3 dimensional (D) cardiac fusion imaging process had the potential for sharing anatomical and physiological informa-

The 16-MSCT can accurately assess LV wall motion.

Double arterial phase SENSE dynamic MRI is as valuable as double arterial phase dynamic MDCT for detecting hypervascular HCCs.