Cardiac CT for myocardial ischaemia detection and characterization—comparative analysis

Abstract

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.

Absolute Versus Relative Myocardial Blood Flow by Dynamic CT Myocardial Perfusion Imaging in Patients With Anatomic Coronary Artery Disease

“…blood flow (MBF) calculated from CT MPI datasets have been reported [2,3,8,[11][12][13]. This may be caused not only by technical or methodologic reasons but also by systematic interindividual differences in MBF.…”

Perfusion Computed Tomography for the Assessment of Myocardial Viability — a Case Series

“…Reversible ischemia can be suspected if hypoattenuation is present only in the stress phase or if the hypoattenuated area increases significantly. 18 In the first case, the presence of ischemia in the anterior wall of the LV was correlated with the presence of a perfusion deficit which was partially reversible during stress acquisition.…”

Coronary Computed Tomography Angiography

“…Despite its many advantages, cCTA is only one out of many clinically approved methods to examine coronary arteries. Although there are notable technical developments in evaluating functional parameters as well [6][7][8], the current indication is predominantly the investigation of anatomical and morphological vessel characteristics. Especially in the exclusion of coronary artery disease (CAD), cCTA plays a decisive role [9][10][11].…”