CT Myocardial Perfusion Imaging: A New Frontier in Cardiac Imaging

Abstract

The past two decades have witnessed rapid and remarkable technical improvement of multidetector computed tomography (CT) in both image quality and diagnostic accuracy. These improvements include higher temporal resolution, high-definition and wider detectors, the introduction of dual-source and dual-energy scanners, and advanced postprocessing. Current new generation multidetector row (≥64 slices) CT systems allow an accurate and reliable assessment of both coronary epicardial stenosis and myocardial CT perfusion (CTP) imaging at rest and during pharmacologic stress in the same examination. This novel application makes CT the unique noninvasive “one-stop-shop” method for a comprehensive assessment of both anatomical coronary atherosclerosis and its physiological consequences. Myocardial CTP imaging can be performed with different approaches such as static arterial first-pass imaging, and dynamic CTP imaging, with their own advantages and disadvantages. Static CTP can be performed using single-energy or dual-energy CT, employing qualitative or semiquantitative analysis. In addition, dynamic CTP can obtain quantitative data of myocardial blood flow and coronary flow reserve. The purpose of this review was to summarize all available evidence about the emerging role of myocardial CTP to identify ischemia-associated lesions, focusing on technical considerations, clinical applications, strengths, limitations, and the more promising future fields of interest in the broad spectra of ischemic heart disease.

Cost-effectiveness of stress CTP versus CTA in detecting obstructive CAD or in-stent restenosis in stented patients

“…It is important to note, however, that despite the growing evidence supporting the diagnostic potentials of CTP, even the latest guidelines do not explicitly recommend this modality, neither for the detection of CAD in general nor for stented patients [2,38]. Until now, there is no consensus of the optimal scanning mode of CTP and the protocols may vary across institutions which hinders the structural implementation of this technique across a broad range of institutions [39]. Additionally, the use of CTP is associated with a higher radiation dose burden and an exact guideline for patient referral to this imaging modality should be drawn up in the future.…”

Possibilities of Stress Computed Tomography Myocardial Perfusion Imaging in the Diagnosis of Ischemic Heart Disease

“…По эффектам и механизмам он подобен аденозину. Дипиридамол также вводят с помощью инфузии, однако за счет более длинного периода полураспада, в отличие от аденозина, для прекращения его действия и купирования симптомов ишемии может потребоваться использование антагониста аденозиновых рецепторов -аминофиллина, поэтому дипиридамол используется реже [10,12].…”

“…Корректировка дозы на массу тела не производится. Благодаря более длительному периоду полувыведения регаденозон можно вводить однократно болюсно, при этом пиковая вазодилатация развивается через 2-4 мин [10,12]. В настоящее время дипиридамол (раствор для инъекций), аденозин и регаденозон не зарегистрированы в Российской Федерации.…”

Clinical Applications of Wide-Detector CT Scanners for Cardiothoracic Imaging: An Update

“…Groothuis et al (42) compared CCTA with MR myocardial perfusion imaging and found that only 42.3% of patients with obstructive coronary arterial disease on CCTA showed myocardial ischemia on MR perfusion. Thus, additional functional assessments, such as fractional flow reserve (FFR) measurements, cardiac single-photon emission computed tomography (SPECT), stress echocardiography, or stress perfusion MR, are needed to determine the indications for revascularization (424344). Recent advances in CT technology have enabled myocardial CT perfusion imaging with high temporal resolution and a reasonable radiation dose.…”